Anatomy compartment syndrome

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohammadmain Rezazadehsaatlou[2] ;


Overview

Compartment syndrome can be found wherever a compartment is present. Possible sites include the lower leg, forearm, wrist, and hand [1][1][2][3][4][5][6] [7][8][9].

Anatomy

Lower leg

The lower leg is divided into 4 compartments.

  • Anterior
  • Lateral
  • Superficial posterior
  • Deep posterior
  • Tibialis posterior

Anterior compartment

Muscles in the anterior compartment are :

  • Tibialis anterior
  • Extensor digitorum longus
  • Extensor hallucis longus
  • Peroneus tertius

The anterior compartment borders are as follows:

  • Tibia
  • Fibula
  • Interosseous membrane
  • Anterior intermuscular septum

Lateral compartment

The lateral compartment includes the peroneus longus and brevis and the common peroneal nerve superficial branch lies Within the compartment:

  • Anterior intermuscular septum
  • Fibula
  • Posterior intermuscular septum
  • Deep fascia

Superficial posterior compartment

The superficial posterior compartment include: the gastrocnemius, soleus, and plantaris. It is surrounded by the deep fascia of the leg.

Deep posterior compartment

The muscles within the deep posterior compartment are as follows:

  • Flexor digitorum longus
  • Flexor hallucis longus
  • Popliteus
  • Tibialis posterior

The borders of the deep posterior compartment are as follows:

  • Tibia
  • Fibula
  • Deep transverse fascia
  • Interosseous membrane

Tibialis posteriorcompartment

The tibialis posterior compartment is a more recently described subdivision of the deep posterior compartment. It consists of the tibialis posterior, which has been shown to have its own fascial layer.

Forearm

Four interconnected compartments of the forearm are recognized, as follows:

  • Superficial volar (flexor)
  • Deep volar
  • Dorsal (extensor) compartment
  • Compartment containing the mobile wad of Henry

The deep volar compartment contains the flexor digitorum profundus, flexor pollicis longus, and pronator quadratus muscles and tendons. The mobile wad of Henry comprises the brachioradialis, extensor carpi radialis brevis (ECRB), and extensor carpi radialis longus muscles and tendons.

Elevated pressures most commonly affect the volar compartments, but the dorsal and mobile wad compartments may also be involved, alone or in addition to the volar compartments. It is usually difficult to clinically differentiate isolated or combined involvement of the deep and superficial volar compartments.

Wrist

In the wrist, most of the soft tissues are bound within rigid compartments for example the volar wrist tendons, for the most part, are tightly constrained within the carpal tunnel (thumb and finger long flexor tendons), except for the flexor carpi radialis, flexor carpi ulnaris, and palmaris longus tendons, which are in separate compartments. The dorsal compartments are primarily channels for tendons and are rarely afflicted by compartment syndrome.

The dorsal extensor tendons pass under an extensor retinaculum and are divided into 6 compartments, as follows:

  • Radial wrist abductor (abductor pollicis longus tendon) and thumb extensor (extensor pollicis brevis tendon) dorsal to the trapezium bone
  • Radial wrist extensors (extensor carpi radialis longus and ECRB tendons) dorsal and radial to the trapezoid bone
  • Extensor pollicis longus tendon
  • Common finger extensors (extensor digitorum communis [EDC] tendon) dorsal to the capitotrapezoid articulation
  • Extensor digiti minimi tendon to the fifth digit
  • Ulnar wrist extensor (extensor carpi ulnaris tendon) in a groove adjacent to the ulnar styloid

Hand

The hand has 10 compartments:

  • Dorsal interossei (4 compartments)
  • Palmar interossei (3 compartments)
  • Adductor pollicis compartment
  • Thenar compartment
  • Hypothenar compartment

References

  1. 1.0 1.1 Erdös J, Dlaska C, Szatmary P, Humenberger M, Vécsei V, Hajdu S (April 2011). "Acute compartment syndrome in children: a case series in 24 patients and review of the literature". Int Orthop. 35 (4): 569–75. doi:10.1007/s00264-010-1016-6. PMC 3066331. PMID 20401657.
  2. Willis RB, Rorabeck CH (April 1990). "Treatment of compartment syndrome in children". Orthop. Clin. North Am. 21 (2): 401–12. PMID 2183136.
  3. Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP (2007). "Acute limb compartment syndrome: a review". J Surg Educ. 64 (3): 178–86. doi:10.1016/j.jsurg.2007.03.006. PMID 17574182.
  4. Tiwari A, Haq AI, Myint F, Hamilton G (April 2002). "Acute compartment syndromes". Br J Surg. 89 (4): 397–412. doi:10.1046/j.0007-1323.2002.02063.x. PMID 11952578.
  5. Mrsiç V, Rasic A, Adam VN, Stojcić EG, Smiljanić A (March 2011). "[Acute compartment syndrome of the muscle in intensive care patients]". Acta Med Croatica. 65 (1): 31–9. PMID 21568072.
  6. Botte MJ, Gelberman RH (August 1998). "Acute compartment syndrome of the forearm". Hand Clin. 14 (3): 391–403. PMID 9742419.
  7. Gerow G, Matthews B, Jahn W, Gerow R (May 1993). "Compartment syndrome and shin splints of the lower leg". J Manipulative Physiol Ther. 16 (4): 245–52. PMID 8340719.
  8. Lerner SM (August 2008). "Review article: the abdominal compartment syndrome". Aliment. Pharmacol. Ther. 28 (4): 377–84. doi:10.1111/j.1365-2036.2008.03747.x. PMID 18513379.
  9. Mars M, Hadley GP (July 1998). "Raised intracompartmental pressure and compartment syndromes". Injury. 29 (6): 403–11. PMID 9813693.