Compartment syndrome, fibromyalgia

What is compartment syndrome?

Increased pressure within a muscle compartment

What is compartment syndrome caused by?

Either:

• decreased compartment size

• increased compartment contents

what is the pathophysiology of compartment syndrome?

Increased compartment pressure leads to edema, which may cause an obstruction in circulation. The obstruction may lead to venous occlusion which only further increases edema. Arterial blood flow becomes compromised and ischemia develops. Fibrotic tissue eventually replaces healthy tissue, which may lead to contracture, disability, and loss of function.

what are the 6 P’s of compartment syndrome?

• Pain out of proportion to injury, pain on passive stretch of muscles

• Pressure

• Paresthesia

• Pallor

• Paralysis

• Pulselessness

What is the management of compartment syndrome?

• Perform regular neurovascular assessments looking for early s/s:

  • pain unrelieved by drugs or out of proportion to injury

  • paresthesia

• Relieve source of pressure - ex. bivalve cast

• Reduce traction weight

• Avoid elevating above heart or using cold compresses

• Fasciotomy if necessary

• amputation if left untx

What are the components of a peripheral vascular assessment?

• Assess for (in both legs - to compare):

  • color

  • temperature

  • capillary refill

  • peripheral pulses

  • edema

What are the components of a peripheral neuro assessment?

• Assess (in both extremities):

  • sensation

  • motor function

  • pain

What is fibromyalgia?

Chronic, nonarticular musculoskeletal pain and fatigue w/multiple tender points

What is the pathophysiology of fibromyalgia?

• pain inhibitor pathways do not work effectively

What are the physical s/s of fibromyalgia?

• Widespread burning that fluctuates, 11/18 tender points

• Head/facial pain, migraines, TMJ dysfunction

• Pain to stimuli that does not typically cause pain

• stiffness, RLS

• IBS, urgency and frequency

• difficulty swallowing

• difficult menstruation

what are the neuro s/s of fibromyalgia?

• difficulty concentration

• lapses in memory

• feeling overwhelmed when multitasking

• depression, anxiety

• non refreshing sleep, fatigue

• paresthesia in hands/feet

what is the tx for fibromyalgia?

• drugs for chronic and widespread pain

  • pregabalin, duloxetine, milnacipin

• low dose tricyclic antidepressants, SSRIs, and benzos for depression/anxiety

• Muscle relaxants and OTC analgesics, opiates

• Ambien for sleep disturbances

• rest

• exercise, sleep, stress reduction

What are the nursing implications for fibromyalgia?

• supportive care - emotional and pain management

• Massage and US

• application of alternating heat and cold

• PT

• exercise: yoga, tai-chi, low impact cardio

what is the patient teaching for fibromyalgia?

• limit sugar, caffeine, and alcohol

• take vitamins and mineral supplements, follow a healthy diet

• avoid miracle diets and supplements

• use relaxation strategies