Hand Compartment Syndrome

Ioannis M Stavrakakis,Theodoros H Tosounidis,George E Magarakis

doi:10.5772/intechopen.95497

Abstract

Compartment syndrome is defined by high pressures in a closed myofascial compartment, which affects initially the muscles and later the nerves and vessels. The hand is rarely affected, but if treated suboptimally, it results to a permanent loss of function. Eleven compartments are included in the hand and wrist. Diagnosis of compartment syndrome of the hand remains challenging. Pain out of proportion of injury and excessive swelling should raise suspicion towards a compartment syndrome. Intracompartmental pressure measurement contributes to the diagnosis, but it is not always reliable. Once the diagnosis of acute compartment syndrome has been made, decompression of all compartments is mandatory, in order to achieve a good outcome. Failing to manage this emergent condition properly leads to a significant hand disability. Our chapter includes the following sections: 1. Introduction. A brief description of the hand compartment syndrome is presented. 2. Anatomy. Special considerations regarding hand compartments are presented, 3. Etiology. 4. Diagnosis. Signs and symptoms are reported, as well as guidelines of the technique of intracompartmental pressure measurement. 5. Treatment. Faciotomies’ indications and operative technique are described in details. 6. Conclusion. Appropriate figures of the clinical image and surgical decompression are presented as well.

Highlights

Compartment syndrome is defined as an elevated pressure of an anatomical compartment up to a level where the tissue blood perfusion is impeded
Patient’s history, clinical image and physical examination are the keystones for the diagnosis of acute compartment syndrome [2]
As there are cases of silent compartment syndrome described in the literature, i.e. severe swelling with no excruciating pain, whenever there is a slight suspicion of Acute compartment syndrome (ACS), Intracompartmental pressure measurement (ICP) measurement should be performed [18]

Summary

Introduction

Compartment syndrome is defined as an elevated pressure of an anatomical compartment up to a level where the tissue blood perfusion is impeded. Acute compartment syndrome (ACS) of the hand is rare, as compared to other areas of the human body, but the consequences are detrimental if treated suboptimally. Severe functional disability of the hand, due to muscles’ contractures, is the inevitable result of a neglected compartment syndrome. Diagnosis of this urgent situation is challenging and it is based mainly on the clinical examination [1–3]. In case there is any doubt towards the diagnosis of ACS or for insensate patients, intracompartmental pressure measurement is used to aid the evaluation [4]. Good knowledge of the special anatomy of the hand is necessary, in order to manage compartment syndrome appropriately. Correct timing of fasciotomies is of paramount importance, in order to achieve a good functional outcome [6]

A Comprehensive Review of Compartment Syndrome

Anatomy - pathophysiology

Etiology

Diagnosis

Treatment

Findings

Conclusion