Travel Reference
In-Depth Information
bow, and ankle. Rupture of muscles and tendons more commonly occurs in the calf, the
frontandbackofthethigh,andtheupperportionofthearmandshoulder.Pain,tenderness,
swelling, and loss of motion are the usual findings. Sometimes a defect in the muscle or
tendon can be felt.
Prehospital treatment should include immobilization, applying cold, and rapid evacu-
ation. Definitive repair of such injuries is most successful if performed within twenty-four
hours of the accident.
Muscle Compartment Syndromes
Some muscles are enveloped in a fibrous sheath or “compartment” that is only slightly
distensible. Swelling of the muscle as the result of unaccustomed exercise or trauma can
raise the compartment pressure to a level that impairs blood flow. When deprived of its
blood supply, the muscle dies, usually crippling the extremity.
Compartment syndromes are uncommon, but because they can produce permanent dis-
ability,theyshouldberecognizedandpromptlytreated.Theanteriortibialismuscle,which
is located on the outside of the shin, is the muscle most commonly affected by compart-
mental compression. Most individuals have an obvious leg injury, typically a crushing in-
jury.However,compartmentalsyndromesareinsidiousbecausetheycandevelopfollowing
unaccustomed exercise. Occasionally pressure on the leg during a period of unconscious-
ness, or injuries such as burns, can produce this disorder. A few individuals have experien-
ced previous episodes of milder pain, particularly following vigorous exercise.
The initial symptom is pain in the involved muscles, which typically is much more
severe than would be expected from the injury or exercise by which it is preceded. Passive
movement or stretching of the muscle is also painful. Usually the muscle is obviously
swollen and the overlying skin is tense and glossy. However, the most diagnostic feature is
severe weakness or paralysis of the involved muscle. A person with an anterior tibial com-
partment syndrome cannot flex the footupwardorresist pressure forcing it down.The foot
may be cold and numb, and the pulses may be weak, but such signs are inconsistent and
their absence is not an indication that a compartment syndrome is not present.
Outside of a hospital, two maneuvers may be beneficial: Any constricting clothing or
bandages should be removed, and the extremity should be positioned at or above heart
level. However, the only effective treatment is to surgically open the compartment to re-
lieve the pressure. Since surgeons alone are familiar with the technique and the anatomy,
individuals with this disorder should be evacuated to a hospital. If evacuation is not pos-
sible, medically trained personnel may be able to perform the procedure with appropriate
guidance.
Evacuation is urgent. Treatment must be prompt to avoid permanent paralysis. Only 31
percent of one group of individuals treated within twelve hours had residual disability; 91
percent of those decompressed later had permanent functional deficits and 20 percent re-
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