Exogenous Peptide Injection Causing Medical Thigh Compartment Syndrome

Compartment syndrome has been defined as “a condition in which increased pressure within a limited space compromises the circulation and function of the tissues within that space”.1 It is most commonly seen after injuries to the leg2-5 and forearm6-8 but may also occur in the arm,9 thigh,10 foot,11-13 buttock,14 hand15 and abdomen.16 It typically follows traumatic injury, but may also occur after ischaemic reperfusion injuries,17 burns,18 prolonged limb compression after drug overdose19 or poor positioning during surgery.20-24 Furthermore, subclinical compartment syndromes may explain the occurrence of a variety of postoperative disabilities which have been identified after the treatment of fractures of long bones using intramedullary nails.25 Approximately 40% of all acute compartment syndromes occur after fractures of the tibial shaft26 with an incidence in the range of 1% to 10%.26-30 A further 23% of compartment syndromes are caused by soft-tissue injuries with no fracture and fractures of the forearm account for 18%.26 Acute compartment syndrome is seen more commonly in younger patients, under 35 years of age31 and therefore leads to loss of function and long-term productivity in patients who would otherwise contribute to the country’s workforce for up to 40 years.

A national survey of acute hospitals in England on their current practice in the use of femoral nerve blocks when splinting femoral fractures

Noninvasive Assessment of Visco-Elasticity in the Presence of Accumulated Soft Tissue Fluid

A patient being treated with androgens developed an acute bilateral compartment syndrome. Androgens are known to cause hypertrophy of muscle, which in a closed fascial compartment may predispose to a compartment syndrome. While an acute syndrome has not been reported previously, patients on androgen therapy frequently complain of cramps and leg pain, which may be manifestations of chronic compartment syndrome. The above case report does not establish a positive cause and effect relationship, but because this occurrence has not been documented before we believe the relationship should be considered. Patients on androgens should be examined for the possibility of compartment syndromes, either acute or chronic. The actual compartment pressures can be measured in suspected cases.

Crush Syndrome: A Case Report and Review of the Literature

The growing prevalence of obesity in the USA has resulted in increased consumption of weight loss products that promote fat metabolism. Dietary supplements used for weight loss contain a wide variety of ingredients but the amount of scientific information available on these ingredients varies considerably. Such supplements have documented and undocumented adverse effects. Although the FDA frequently issues health advisories, the health consequences of consuming supplements are often overlooked by the general public. A common supplement used for weight loss is Hydroxycut. The ingredients used in the different forms of Hydroxycut products vary but generally include caffeine and green tea extract, which are responsible for a wide range of adverse effects. We present the case of 41-year-old man with a medical history of polysubstance abuse who developed acute compartment syndrome in the setting of rhabdomyolysis from prolonged immobilisation and the use of Hydroxycut. This case demonstrates the possible adverse effects of consuming weight loss herbal supplements like Hydroxycut. Healthcare professionals and consumers are encouraged to report serious adverse events or product quality problems with the use of these supplements to the FDA’s MedWatch adverse event reporting program.LEARNING POINTSThe weight loss supplement Hydroxycut is sold in various formulations whose side effect profiles are not fully known; the latest formulation has a very high concentration of caffeine which increases the risk of rhabdomyolysis.Although uncommon, exercise-induced rhabdomyolysis can cause compartment syndrome, especially in the setting of concurrent use of weight loss supplements.High clinical suspicion, prompt diagnosis and early treatment are key to preventing complications from compartment syndrome.

Chronic compartment syndrome (CCS), though often described in athletes, can occur in patients with long-standing lymphedema due to chronic fibrotic changes in the skin, subcutaneous tissue, and deep fascia. We present a unique case of CCS in a patient with advanced secondary lymphedema of the left lower limb. She underwent multiple sittings of vascularized lymph node transfers and lymphovenous anastomoses. Her final lymph node transfer, combined with bariatric surgery, led to dramatic weight loss and a reduction in lower limb girth. Subsequently, she developed persistent exertional pain and neuropathic symptoms in the left calf, raising suspicion for CCS. Intracompartmental pressure (normal range of 0–10 mm Hg) analysis by manometry confirmed CCS with preoperative readings of 22, 25.2, 17.9, and 29.5 mm Hg in anterior, lateral, superficial, and deep compartments of the leg. Surgical decompression and debulking resulted in postdecompression pressures of 6.5, 6, 4.6, and 4.6 mm Hg, respectively, with good symptomatic relief. This case emphasizes the importance of considering CCS in chronic lymphedema with limb pain and neuropathy unexplained by surgical outcomes.

Orthopedic pitfalls in the ED: neurovascular injury associated with posterior elbow dislocations

Wrist drop, a common motor deficit seen with radial neuropathy, is typically a result of nerve damage from acute trauma or external compression. Diagnosis is initially suspected by clinical examination, and initial management consists of splinting the wrist, physical therapy, and referral for consideration of outpatient surgical management if it doesn't resolve with conservative measures. While this is commonly managed in the outpatient setting, the emergency physician should keep a broad differential when evaluating patients with wrist drop, as there are rare causes of wrist drop that may require emergent surgical management. In this report, we discuss a case of wrist drop due to compartment syndrome.We present a case of a male in his early 30s who presented to the emergency department (ED) with left upper extremity numbness and weakness noticed upon awakening. Examination revealed tense compartments in the left forearm with associated wrist drop. Laboratory workup revealed rhabdomyolysis with multi-organ failure, and the patient was taken for emergent fasciotomy with orthopedic surgery.This report highlights a case of acute compartment syndrome in a critically ill patient who initially presented to the ED with wrist drop. The case demonstrates the need for emergency physicians and other acute care clinicians to keep a broad differential in patients presenting with acute peripheral neuropathies. This rare cause of radial neuropathy warrants consideration, as prompt recognition, diagnosis, and emergent management of compartment syndrome are needed to prevent life and limb-threatening morbidity and mortality.

Household expenditures on dietary supplements sold for weight loss, muscle building, and sexual function: Disproportionate burden by gender and income

Objective: We present the case of a 14-year-old Factor VIII-deficient patient with no history of trauma, who developed acute spontaneous compartment syndrome of the volar forearm. We also suggest a treatment strategy. Methods: Fasciotomy with hematoma evacuation and ipsilateral carpal tunnel release was performed, and the wound was closed with vascular loops in “Jacob's ladder” fashion. Factor infusions were continued overnight. Results: The volar forearm compartment was successfully decompressed, and the patient's coagulopathy was managed with appropriate clotting factors. Conclusions: Hemophilic patients warrant special consideration and multispecialty care; with replenished coagulation factors and timely surgical decompression, they can expect satisfactory recovery of muscular and neurological function.

Between 10 and 23% of bleeding episodes in the musculoskeletal system of haemophilia patients occur in the muscles. Until now, the most widely accepted treatment for muscle haematomas in patients with haemophilia has been a combination of rehabilitation and intravenous infusion of replacement clotting factor, until the haematoma completely disappears. The only way to prevent muscle bleeds in haemophilia is primary haematological prophylaxis (from cradle to college). Home treatment is currently the standard of care for patients with severe haemophilia. When a muscle bleed is suspected, confirmation must be achieved by means of imaging tests (ultrasound, MRI, CT). Then, immediate (early) enhanced on-demand haematological treatment must be started until the full disappearance of the haematoma. If untreated, muscle bleeds can cause complications such as nerve injury, compartment syndrome, myositis ossificans, pseudotumour, and even infection (abscess). Currently, the literature for muscle hematomas in the nonhaemophiliac population suggests that ultrasound-guided percutaneous drainage, or surgical drainage performed as open surgery if percutaneous drainage fails, could be beneficial in terms of achieving better and faster symptom relief. Ultrasound-guided haematoma evacuation is a well tolerated procedure. However, the proportion of unsuccessful evacuations and hematoma recurrence is substantial (13%). Such a rate of unsuccessful evacuation is because of excessive density and/or viscosity of the content. Ideally, haematoma evacuation must be performed before 3-5 days since the beginning of the muscular bleed. Although we have not found publications about ultrasound-guided decompression of muscle haematomas in haemophilia, the current status of progress in both the haematological and ultrasound fields leads us to think that this technique should be increasingly considered for the treatment of haemophilia patients, especially in the case of large haematomas in the liquid phase.

Point-of-Care Ultrasound Diagnosis of High Flow Priapism.

Emergency Department Evaluation and Treatment of Acute Hip and Thigh Pain

Acute compartment syndrome of the anterior compartment of the arm following a traumatic distal biceps rupture with rupture of a high-take off radial artery: A case report