Compartment Syndrome In Children

What is compartment syndrome?

Compartment syndrome (SIN-drohm) is a condition that occurs when pressure increases within a compartment (closed space) in your body. Inside this compartment are muscle tissues, nerves, and blood vessels that are enclosed by a fascia. The fascia is a thick layer of special protective tissue that does not expand (grow). Compartment syndrome happens when there is swelling in the compartment. This swelling inside the compartment puts pressure on the muscles, blood vessels, and nerves. Blood flow inside the compartment may be blocked and lead to injuries of the muscle and nerves. Over time, your child's injured limb (arm, leg, hand, or foot) may not work anymore as a result of the increasing pressure.

What causes compartment syndrome?

Compartment syndrome may be caused by any of the following:

• Direct pressure: Bandages or casts that are too tight.
  
  
• Fracture or crush injuries: The most common cause of acute compartment syndrome is a broken bone. In children, the break is usually in the shin bone (lower leg) or arm. Getting trapped under a heavy object or lying in an awkward position after fainting may also cause compression (pressure in the compartment).
  
  
• Medicines or illegal drugs: Blood thinners or clot busters used in preventing or treating blood clots may cause bleeding in the compartment. Medicines that are injected through the veins may also increase pressure.
  
  
• Soft tissue injury and other medical conditions: Direct blows, car accidents, or falls may cause injuries and bleeding which lead to compartment syndrome. Burns, bleeding problems, infections, allergies, or insect or snake bites can also lead to compartment syndrome.
  
  
• Surgery: Having lengthy surgery where your child's legs are raised to a level that is higher than his heart.

What are the signs and symptoms of compartment syndrome?

Pain is the earliest symptom of compartment syndrome. The pain usually increases when the injured area is stretched or bent. Your child may not be easily quieted due to extreme (very bad) pain. He may need more medicine to control or relieve his pain. Your child's limb may be numb, hard, swollen, or have a full feeling as if fluids are filling it. His skin may be pale or shiny and he may have trouble moving the injured limb.

How is compartment syndrome diagnosed?

One or more of the following tests may be done: :

• Blood tests: Your child may need blood tests to give caregivers information about how his body is working. The blood may be taken from your child's arm, hand, finger, foot, heel, or IV.
  
  
• Doppler flowmetry: This test checks the flow of blood in your child's muscles. This may help caregivers feel or hear the blood flow in the injured compartment.
  
  
• Magnetic resonance imaging scan: This test, also called an MRI, uses magnetic waves to take pictures. During an MRI, pictures are taken of your child's bones, muscle, joints, and blood vessels. He will need to lie still during an MRI. Never enter the MRI room with an oxygen tank, watch, or any other metal objects. This may cause serious injury.
  
  
• Muscle compartment pressure measurement: The increased pressure within the compartment may be measured with special tools. A long needle attached to a special machine that measures pressure is put into the injured muscle.
  
  
• Near infrared spectroscopy: This test uses infrared (light beam) to show changes in the muscle.
  
  
• Scintigraphy: This is a test to look at the flow or movement of blood through the compartment area. Your child will be given a small amount of dye in an IV. Pictures are then taken of your child's blood vessels, muscles, or bones.
  
  
• Urine test: A sample of your child's urine is collected and sent to the lab for tests. This may help caregivers know when muscles are breaking down and if his kidneys are affected.

How is compartment syndrome treated?

If your child has a cast or bandages caregivers may remove them. Doing this may decrease pressure in your child's muscles. He may also need one or more of the following:

• Brace or crutches: Your child may need to wear a brace to keep his limb from moving. This brace may correct, support and protect the body part. Caregivers may also tell your child to use crutches to decrease stress and strain on his legs.
  
  
• Surgery: Caregivers may do a fasciotomy to decrease pressure and swelling. A long incision (cut) may be done in the fascia of the injured compartments.
  
  
• Rehabilitation: This is a program that helps your child bring back his limb's normal range of motion and strength. A physical or occupational therapist may exercise his arms, legs, and hands. They may also teach him new ways to do daily activities and care for himself. This therapy teaches your child special skills for bathing, dressing, or eating.

What problems can compartment syndrome cause?

If compartment syndrome is not treated quickly, your child may develop an infection. The nerves of the arm or leg with this problem may be hurt or stop working, and he may not be able to move the limb. Scars may form and the limb may not look or work the same as before. Your child may need surgery to remove the arm or leg. He may develop kidney or heart problems as a result of compartment syndrome.

How can compartment syndrome be prevented?

• You may be asked to keep your child's limb raised if he gets injured. If he needs to wear a cast, brace or bandage, prop the injured limb on a pillow to be at the same level as his heart. Raising his limb higher than this may cause compartment syndrome.
  
  
• Let your child rest right away if he feels muscle pain while exercising.
  
  
• Make sure his bandages are not too tight.
  
  
• Your child should do warm-up or stretching exercises before exercising his arm and leg muscles. Ask your child's caregiver for an exercise program, such as cross-training, to use different muscles.
  
  
• Your child should wear shoes with soft cushion, flexible soles and low heels. He should avoid running on hard surfaces.

Where can I find support or more information?

Compartment syndrome may be life-changing for your child and your family. You, your child, and those close to you may feel afraid and worried. These are normal feelings. Talk to your child's caregivers, your family, or friends about your feelings. Contact the following for more information about compartment syndrome:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

• American Academy of Orthopaedic Surgeons
  6300 North River Road
  Rosemont , IL 60018-4262
  Phone: 1- 847 - 823-7186
  Web Address: http://www.aaos.org/
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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