Miles O’Brien’s Arm Amputation: 10 Things to Know about Compartment Syndrome

“I wish I had a better story to tell you about why I am typing this with one hand (and some help from Dragon Dictate).”

So wrote former CNN and PBS science and space aviation reporter Miles O’Brien on his personal blog yesterday, talking about the above the elbow amputation he underwent about 10 days ago. Ruling out “shark attack … assassination attempt… and skydiving mishap” O’Brien reveal that the cause was much more prosaic:

“I had finished my last shoot after a long reporting trip to Japan and the Philippines and was stacking the Pelican cases brimming with TV gear onto my cart. As I tried to bungee cord them into some semblance of security for movement, one of the cases toppled onto my left forearm. Ouch! It hurt, but I wasn’t all “911” about it. It was painful and swollen but I figured it would be okay without any medical intervention. Maybe a little bit of denial?”

Although the arm hurt the next day, he didn’t think much about it until the pain and swelling got worse and was seen by a physician. The doctor diagnosed Anterior Compartment Syndrome ( a build up of pressure in the arm) and immediately put him in the hospital. While there, the arm developed a dusky color, and more alarmingly, became numb. ” The doctor recommended an emergency fasciotomy to relieve the pressure. ”

Things did not go well in the operating room. As Miles put it:

“I lost blood pressure during the surgery due to the complications of compartment syndrome, the doctor made a real-time call and amputated my arm just above the elbow. He later told me it all boiled down to a choice…between a life and a limb.”

Ten Things to Know about Compartment Syndrome

1. Limbs are divided into multiple sections. If you look at a cross section of an arm or leg (right), you can see that is divided into section, called fascial compartments. These compartments are created (and bounded) by tough, unstretchable connective tissue called fascia. The compartments contain muscles along with the blood vessels and nerves that run alongside them.

2. When muscles become swollen, they can fill the compartment to capacity, causing interference with nerves and blood vessels as well as damage to the muscles themselves. The resulting painful condition is referred to as compartment syndrome.

3. Compartment syndrome may be caused by a one-time traumatic injury (acute compartment syndrome), such as a fractured bone or a hard blow to the thigh, by repeated hard blows (depending upon the sport), or by ongoing overuse (chronic exertional compartment syndrome- CECS), which may occur, for example, in long-distance running. Pain in CECS occurs only during the activity which as caused the problem.

4. Compartment syndrome is most common in the lower leg and forearm, although it can also occur in the hand, foot, thigh, and upper arm.

5. Causes of Acute Compartment Syndrome include:

• Fractures
• Crush injuries
• A blood clot in an arm or leg
• Overly tight bandaging
• Burns
• Blood vessel surgery on a limb
• Prolonged pressure on a limb while unconscious
• Anabolic steroids can also contribute to developing compartment syndrome

6. There are 6 “Ps” associated with compartment syndrome —

• pain- classically “out of proportion” to what is expected based on the physical exam findings,
• paresthesia- “pins and needles”, burning or numb sensation
• pallor- paleness
• paralysis- the inability to move the extremity
• pulselessness- being unable to feel the pulse in that section
• poikilothermia- inability to regulate temperature in that area

7 Acute compartment syndrome is a medical emergency. When the pressure inside a compartment exceeds the pressure inside the veins, blood cannot flow properly. Oxygen and nutrients cannot get to the muscles and nerves, leading to tissue damage. Severe cases can lead to tissue death (necrosis), generalized infection (sepsis) and death. Seek medical attention as quickly as possible.

8. There are no non-surgical treatments for acute compartment syndrome. It is a surgical emergency. The main treatment for compartment syndrome is fasciotomy. In a fasciotomy, a surgeon makes a long incision (or sometimes several incisions) through the skin and fascia to relieve the pressure. The wounds are covered with sterile dressing, and can usually be closed 2 to 3 days later.

9. Complications of compartment compression include permanent injury to the nerves and muscle that pass through the compartment. This can impair the function of that limb. In more severe cases, amputation may be required.

10. Chronic exertional compartment syndrome is usually less serious. Avoiding the inciting exercise or switching to another form of exercise is one method of treatment. Stretching and physical therapy is also used.