Can anyone explain Compartment Syndrome to me in easy layman's terms?

[Klio]

In a nutshell my bil is in intensive care after being found unconscious in his flat, we believe for the best part of 48 hours. He was lying in an awkward position when found with his legs bent up underneath him. One result of this is that his left leg is totally numb, except for the odd intense pain that shoots down it. The doctors haven't said much to us but have mentioned that they believe he has compartment syndrome and is likely they will have to operate, but haven't explained it further. I had a look on the internet last night but the sites were heavy on medical jargon and I'll be honest and say that my historian brain just didn't understand them very well! There seemed to be dire warnings about limd amputation and all sorts that has freaked my dh out totally.

Can anyone give me some simple and clear information to help reassure dh.

TIA

no idea about it, but wanted to wish your bil well and bump this for you.

I'll do my best.

It is basically to do with pressure builing up inside spaces which can expand beyond their limit.

The muscles in the body are surrounded by fibrous tissues which are flexible but also only of limited capacity (so the muscles can only get so big or they will burst- like the skin around a sausage!)- these are the 'compartments'. Also running down the limbs are blood vessels and nerves and the whole lot is surrounded by skin which also can only expand and stretch a limited amount.

Compartment symdrone is where (for whatever reason, usually injury) the muscles get very swollen and full of fluid, as so the 'compartment' gets very full and tight. When that happens, the other things in the limbs such as the blood vessels and nerves get squashed. If this is severe, it can prevent sensation, movement and blood flow to areas further away in the limb (hands, feet, etc). Obviously, once that happens it becomes an emergency to do something to release the pressure within that limb and restore the blood supply before the limb becomes too damaged and dies (requiring amputation). The operation is called a fasciotomy, which involves making slits through the skin and into the muscle compartments to allow the pressure within them to release and stop squashing the nerves and blood vessels.

I hope your BIL improves. Don't be scared if he needs surgery- it may improve the situation drastically and save his limb.

All the best and I hope that my explanation makes some sense.

The second line is meant to say CAN'T expand...

Thank you for your information, emma and for the good wishes from you all. That has a gone a long way to reassure us. bil is still stable but not much information at the moment

Emma - I have another question for you if you don't mind The doctor spoke to dh yesterday and said that bil has passed the acute stage and so operating is not an option, they just have to wait and see if the pressure will relieve itself and whether bil will regain the use of his leg. The doc was being pretty non committal as is understandable as they don't know yet what is going to happen, but if the leg doesn't get better would that mean that the limb would die so they will have to amputate it? Dh is really stressed atm especially as bil is his twin so has all those twin connections going on iyswim.

Also I assume you have knowledge of the NHS so if it is going to be long term rehabilitation do you think he would be able to move to a hopsital nearer to us to receive that care? Is that ever done? The problem is that we are nearly 2 hours away and the nearest relatives to him. bil is quite an introverted person and doesn't have a close circle of friends and gets depressed v easily. I suppose the worry dh has is that if we can't visit him every day then he oculd be left with no visitors and that could set back his recovery.

Klio, so sorry to hear that your BIL is in intensive care. I am not Emma, but might be able to answer your questions.

I think, from what I have read, that fasciotomy is the treatment of choice in acute compartment syndrome. But as your BIL had collapsed 48 hours before being admitted to hospital, then there is a problem with doing surgery. There is evidence that performing this surgery after 35 hours of injury, can cause lots of problems, including infection & death. So, you can see that the doctors would not want to operate.

I think that for your brother in-law, the question will be not so much regarding his ability to use his leg, but whether the blood supply restores itself, and therefore retains its 'life'.

With regards to the hospital, I am sure that something could be arranged as your brother in-law stabilises. It is quite common for people to be transferred for all sorts of reasons.

Thanks for your info lou, really appreciate it. From what you have said I presume it is a case of blood supply going back to normal, if not the limb will have to be amputated, is that right?

That is good to know that there could be a chance for him to be moved if needs be, that will reassure dh a lot

Hi Klio,

Sorry I haven't caught your message until now.

What Lou says is correct. The outcome is dependent on whether the blood supply improves and the leg is still able to function (even if just a little). If the blood supply is completely cut off for a long period of time, the leg could become gangerous and potentially become a source of infection (which could be life-threatening in itself)- that is why they would chose to amputate in these circumstances.

Regarding a rehab placement- it is certainly worth making your concerns about the location of BIL's eventual move known to his medical team sooner rather than later. There can be a lot of difficulty with getting PCTs and Social Services to cough up money for rehab placements in a different area to where the patient lives. It CAN be done, but may take some time to arrange, hence my suggestion to get in early with your request. I think you have a valid point about him needing company and support as he may be there a while if he needs prolonged rehab.

I hope that he is improving and more stable now. Your dh must be terribly worried. Do they know why he was unconscious for so long in the first place?