- See:
-
Burns of the hand:
-
High Pressure Injection Injuries:
- Antebrachial Compartment Syndrome:
-
forearm flexors
- causes:
- may follow
supracondylar fr(x) of humerus, or both bone forearm fractures;
- compartment syndromes in the forearm after wrist fractures usually involve the volar compartment;
-
Volkmann's ischemic contracture may result from delayed diagnosis;
- results in ischemic contracture with severe muscle fibrosis & neuropathy;
- may result in functionless extremity w/ few treatment options for improvement;
- examination reveals tense compartment & paresthesias in median nerve distribution;
- passive extension of the digits or wrist increases pain;
-
technique of forearm fasciotomy:
- requires decompression extending from wrist to midarm including:
- lacertus fibrosus
- deep fascial compartments over flexor carpi ulnaris;
- edge of the flexor superficialis muscles
- median nerve involvement:
-
median nerve neuropathy, in addition to carpal tunnel release, requires exploration of nerve in proximal forearm;
- three main areas of potential nerve compression are:
- bicipital aponeurosis (lacertus fibrosis);
- proximal edge of
pronator teres;
- proximal edge of
FDS;
- Compartment Syndrome of Hand:
- occur most often from iatrogenic injuries (A-line or infiltration of IV medications);
- patients are often ventilated, obtunded, or seriously ill leading to delayed dx;
- patients symptoms may be non specific as compared to other compartment syndromes;
- early recognition of this complication is based on physical examination;
- unlike other compartment syndromes, hand compartment syndromes, lack abnormalities in sensory nerves, as no nerves are found within compartment;
- diagnosis should be considered when there is a non specific aching of the hand, precipitated by repetitive strenuous activity;
- increased pain, loss of digital motion, and continued swelling suggest impending compartment syndrome;
- often the physician will note a tight swollen hand in a intrinsic minus position;
- digits are found w/ MP extension and PIP flexion;
- intrinsic tightness becomes evident on exam as motion of PIP joint becomes dependent on position of the metacarpophalangeal joint;
- more proximal interphalangeal motion is possible w/ MP flexion than with metacarpophalangeal extension;
-
pressure measurement
- should have a lower threshold than in leg compartments;
- pressures greater than 15-20 mm is a relative indication for release;
-
surgical treatment of hand compartment syndrome:
- anatomy: 10 separate osteofascial compartments which typically can be released w/ carpal tunnel release and 1 or 2 dorsal incisions;
-
dorsal interossei (4 compartments)
-
palmar interossei (3 compartments)
-
adductor pollicis
- thenar and hypothenar
-
transverse carpal ligament requires release;
- dorsal metacarpal incisions:
- 2 longitudinal dorsal hand incisions are carried over 2nd & 4th metacarpals;
- extensor tendons are retracted, allowing access to dorsal and volar interosseous compartments which are separate;
- these compartments are opened by longitudinal slits;
- dorsal incisions can generally be closed primarily, and delayed primarily closure, w/ or w/o skin grafting, is required for volar surface incision;
Compartment syndromes of the forearm: diagnosis and treatment.
Decompression of forearm compartment syndromes.
Compartment syndrome in the forearm following fractures of the radial head or neck in children.
A cadaveric and radiologic assessment of catheter placement for the measurement of forearm compartment pressures.
Compartment syndromes of the hand. J Bone Joint Surg Am 1996;78:1515-1522
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