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Compartment Syndrome, Chronic CLINICAL Compartment Syndrome, Chronic REVIEW Indexing Metadata/Description › Title/condition: Compartment Syndrome, Chronic › Synonyms: Chronic exertional compartment syndrome; exercise-induced compartment syndrome; recurrent compartment syndrome; subacute compartment syndrome; chronic exertional compartment syndrome; compartment syndrome, chronic exertional; compartment syndrome, exercise-induced; compartment syndrome, recurrent; chronic compartment syndrome › Anatomical location/body part affected: Most often affects the lower leg, especially the anterior and lateral compartments,(35) but can affect all compartments, including gluteus, foot, shoulder, hand(35), upper leg, and forearm(1) › Area(s) of specialty: Orthopedic rehabilitation, sports rehabilitation, cardiovascular rehabilitation › Description • Compartment syndrome – “A condition in which the circulation and function of tissues within a closed space are compromised by increased pressure within that space”(2) • There are two types of compartment syndrome, acute and chronic. Acute compartment syndrome is a surgical emergency;(2) please see Clinical Review…Compartment Syndrome, Acute; Item Number: T708485 for details • Chronic compartment syndrome– A reversible rise in tissue pressure to abnormal levels brought on by exertion and relieved by rest that occurs within an enclosed space and has the potential to threaten perfusion and tissue viability(2) • The prevalence of chronic compartment syndrome is not known since it is not uncommon for patients to administer self-directed treatment or activity modification and not seek medical attention(32) • 95% of all chronic compartment syndrome cases affect the leg(32) Authors › ICD-9 codes Ellenore Palmer, BScPT, MSc • 729.7 nontraumatic compartment syndrome Cinahl Information Systems, Glendale, CA Andrea Callanen, MPT • 729.71 nontraumatic compartment syndrome of upper extremity: nontraumatic Cinahl Information Systems, Glendale, CA compartment syndrome of shoulder, arm, forearm, wrist, hand, and fingers • 729.72 nontraumatic compartment syndrome of lower extremity: nontraumatic Reviewers compartment syndrome of hip, buttock, thigh, leg, foot, and toes Andrea Callanen, MPT • 958.90 compartment syndrome, unspecified Cinahl Information Systems, Glendale, CA • ICD codes are provided for the reader’s reference, not for billing purposes Abigail Grover Snook, PT, MS, MEd Cinahl Information Systems, Glendale, CA › ICD-10 codes Rehabilitation Operations Council • M62.2 ischemic infarction of muscle (non-traumatic compartment syndrome) Glendale Adventist Medical Center, • ICD codes are provided for the reader’s reference, not for billing purposes Glendale, CA › G-Codes Editor • Mobility G-code set Sharon Richman, MSPT –G8978, Mobility: walking & moving around functional limitation, current status, at Cinahl Information Systems, Glendale, CA therapy episode outset and at reporting intervals –G8979, Mobility: walking & moving around functional limitation; projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end January 8, 2016 reporting Published by Cinahl Information Systems, a division of EBSCO Information Services. Copyright©2016, Cinahl Information Systems. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher. Cinahl Information Systems accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 –G8980, Mobility: walking & moving around functional limitation, discharge status, at discharge from therapy or to end reporting • Changing & Maintaining Body Position G-code set –G8981, Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals –G8982, Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset , at reporting intervals, and at discharge or to end reporting –G8983, Changing & maintaining body position functional limitation, discharge status, at discharge from therapy or to end reporting • Carrying, Moving & Handling Objects G-code set –G8984, Carrying, moving & handling objects functional limitation, current status, at therapy episode outset and at reporting intervals –G8985, Carrying, moving & handling objects functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting –G8986, Carrying, moving & handling objects functional limitation, discharge status, at discharge from therapy or to end reporting • Self Care G-code set –G8987, Self care functional limitation, current status, at therapy episode outset and at reporting intervals –G8988, Self care functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting –G8989, Self care functional limitation, discharge status, at discharge from therapy or to end reporting • Other PT/OT Primary G-code set –G8990, Other physical or occupational primary functional limitation, current status, at therapy episode outset and at reporting intervals –G8991, Other physical or occupational primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting –G8992, Other physical or occupational primary functional limitation, discharge status, at discharge from therapy or to end reporting • Other PT/OT Subsequent G-code set –G8993, Other physical or occupational subsequent functional limitation, current status, at therapy episode outset and at reporting intervals –G8994, Other physical or occupational subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting –G8995, Other physical or occupational subsequent functional limitation, discharge status, at discharge from therapy or to end reporting › . G-code Modifier Impairment Limitation Restriction CH 0 percent impaired, limited or restricted CI At least 1 percent but less than 20 percent impaired, limited or restricted CJ At least 20 percent but less than 40 percent impaired, limited or restricted CK At least 40 percent but less than 60 percent impaired, limited or restricted CL At least 60 percent but less than 80 percent impaired, limited or restricted CM At least 80 percent but less than 100 percent impaired, limited or restricted CN 100 percent impaired, limited or restricted Source: http://www.cms.gov . › Reimbursement: No specific issues or information regarding reimbursement have been identified › Presentation/signs and symptoms • Presentation – there is a variety of different presentations(39) –Gradual onset of symptoms(3,4) –Patients typically present with a long duration of preexisting symptoms(32) –Symptoms frequently occur during repetitious movements (e.g., jogging, biking) and will cease once activity stops(3,5,25) –Over time, a low-intensity ache may persist even when activity has ceased(3) –Typically occurs bilaterally and at the same point (duration/intensity) during exercise(6) –Most often affects the lower leg compartments(1) - Anterior compartment – most often affected - 95% of cases occur in anterior compartment(40) - Lateral compartment - Superficial posterior compartment - Deep posterior compartment –Also reported in the thigh, forearm, and foot(27) - Thigh contains 3 compartments: anterior, posterior, and medial - Forearm contains 2 compartments: anterior and posterior - Foot contains the medial, lateral, superficial, and deep compartments –Signs/symptoms - Pain during exercise at a predictable point that resolves with cessation of activity(7) - Pain gradually intensifies to be severe enough to prevent the individual from continuing activity such as running or walking(26) - Mild weakness or tenderness of muscle group of impaired compartment(7) - Soft tissue within the affected compartment feels tense/tight(27) - Physical examination is asymptomatic at rest(7) - Burning, cramping, and aching over involved compartment during and immediately following exertion(4,6) - Paresthesia (e.g., numbness, tingling) corresponding to the nerve within the affected compartment during aggravating activity(3,4,27) - Paresthesia occurs over the dorsal aspect of the foot if the anterior compartment is affected(27) - Paresthesia occurs on the plantar aspect of the foot if the deep compartment is affected(27) Causes, Pathogenesis, & Risk Factors › Causes • Result of increased or prolonged exertion (exercise) that leads to elevated pressure in the involved compartment(2,4) • Other potential causative factors(2,4) –Sudden escalation in training –Alteration in type of surface practiced/trained on –New footwear –Faulty biomechanics › Pathogenesis • The pathophysiology is not fully understood. Hypotheses include the following: –Muscle volume normally increases during exercise; however, in chronic compartment syndrome, the osseofascial compartment is unable to accommodate to the increase in size associated with muscle contraction and swelling. The increased volume increases intracompartmental pressure and reduces perfusion of the tissues within the fascial compartment and ischemia
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