Compartment syndrome: Neuromuscular complications and electrodiagnosis

Abstract

Compartment syndrome (CS) is a treatable condition characterized by elevated intracompartmental pressure and may be acute or chronic in nature. Sustained elevated compartment pressure can lead to ischemia and necrosis of muscle as well as injury to peripheral nerves, creating a deficit that may be neuropathic, myopathic, or mixed. While electrodiagnostic assessments are of limited utility in the diagnosis of acute/traumatic CS, they can assist with prognosticating return of function after surgical fasciotomy or in clarifying the injury pattern in cases in which a traumatic injury results in subsequent neuromuscular deficits. They can also be used to rule out conditions that mimic chronic exertional CS. During electrodiagnostic assessment, clinicians should be aware of patterns associated with muscle fibrosis vs denervation and use this information to assist with prognostication and appropriate counseling for patients regarding any interventional or adaptive treatments that may help restore function.

Vasculitic Tibial Mononeuropathy Associated with Inherited Immune Dysregulation: A Review of Tibial Mononeuropathies with Electrodiagnostic Considerations

“…However, soft tissue injuries without fracture account for nearly a quarter of compartment syndrome. Acute exertional compartment syndrome has also been reported and typically associated with anabolic steroid use and rapid increases in athletic training [6]. Our patient's history of progressively worsening right lower extremity weakness and pain in the absence of risk factors for compartment syndrome made this clinical entity unlikely.…”

Impending Upper Arm Compartment Syndrome Secondary to Intravenous Fluid Infiltration

“…Instead, a distinct pocket of intravenous fluid was identified at the time of surgical intervention, which remained discretely contained between the fascial planes. Typically, signs of reversible muscle damage can be seen with four hours of ischemia, but it can take around eight hours for irreversible damage to the muscles to occur [15]. It is likely that surgical intervention in our case was performed quickly enough to avoid noticeable muscle necrosis.…”

Intraoperative acute compartment syndrome of the upper limb secondary to extravasation

“…Treating acute compartment syndrome involves decompression as early as possible to prevent irreversible changes in the tissues which can occur within 6–8 hours 42 43. Initial measures such as loosening of constrictive dressings and maintaining limb elevation to the level of the heart should be undertaken to maintain arterial perfusion 1 6 25 44.…”