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  <head>
    <title>075-02 Fascia, compartments, neurovascular pathways, and mechanical integration</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Fascia, compartments, and pathways">
      <outline text="Connective tissue as a mechanical network">
        <outline text="Matrix components">
          <outline text="Collagen tensile strength, elastin recoil"/>
          <outline text="Proteoglycans bind water"/>
        </outline>
        <outline text="Fibroblasts remodel matrix under load">
          <outline text="Matrix is active, not inert packing"/>
        </outline>
        <outline text="Loose tissue permits movement"/>
        <outline text="Dense regular fibres align with force">
          <outline text="Orientation reflects loading history"/>
        </outline>
        <outline text="Single fascial chain claims exceed evidence">
          <outline text="Local mechanical relations are established"/>
        </outline>
      </outline>
      <outline text="Superficial, deep, and visceral fascia">
        <outline text="Superficial fascia beneath dermis">
          <outline text="Skin mobility, energy storage, insulation"/>
          <outline text="Dense and tethered in scalp, palm, sole"/>
        </outline>
        <outline text="Deep fascia forms septa and compartments">
          <outline text="Openings can become entrapment sites"/>
        </outline>
        <outline text="Visceral fascia suspends organs">
          <outline text="Some spaces real, some conceptual planes"/>
          <outline text="Describe boundaries and contents"/>
        </outline>
      </outline>
      <outline text="Compartments as pressure-volume systems">
        <outline text="Bounded by relatively unyielding tissue"/>
        <outline text="Rising volume raises pressure">
          <outline text="Impairs venous outflow and perfusion"/>
          <outline text="Impairs nerve conduction and muscle viability"/>
        </outline>
        <outline text="Acute compartment syndrome">
          <outline text="Commonly follows fracture or crush"/>
          <outline text="Early: disproportionate pain, stretch pain"/>
          <outline text="Pulses may remain"/>
          <outline text="Compelling syndrome needs urgent decompression"/>
        </outline>
        <outline text="Abdominal compartment syndrome">
          <outline text="Reduces renal perfusion and venous return"/>
          <outline text="Decompress, optimise fluid, drain, operate"/>
        </outline>
        <outline text="Intracranial and orbital enclosure">
          <outline text="Nonlinear once compensation is exhausted">
            <outline text="Swelling becomes secondary injury"/>
          </outline>
        </outline>
      </outline>
      <outline text="Arterial pathways">
        <outline text="Elastic, then muscular arteries, then arterioles"/>
        <outline text="End arteries versus functional end arteries"/>
        <outline text="Collaterals depend on anastomoses and time">
          <outline text="Gradual stenosis allows enlargement"/>
          <outline text="Acute occlusion may still infarct"/>
        </outline>
        <outline text="Watershed zones vulnerable to hypoperfusion"/>
        <outline text="Protected planes, compression at tunnels"/>
        <outline text="Surgical exposure protects perforators"/>
      </outline>
      <outline text="Venous pathways">
        <outline text="Superficial and deep systems">
          <outline text="Perforators connect, valves direct flow"/>
        </outline>
        <outline text="Muscle contraction and breathing aid return"/>
        <outline text="Valveless plexuses allow two-way spread">
          <outline text="Vertebral veins: metastasis and infection"/>
          <outline text="Facial veins reach intracranial sinuses"/>
        </outline>
        <outline text="Portal systems: two capillary beds in series">
          <outline text="Portal hypertension enlarges anastomoses">
            <outline text="Varices can bleed lethally"/>
          </outline>
        </outline>
      </outline>
      <outline text="Peripheral nerves">
        <outline text="Roots form plexuses">
          <outline text="Each nerve carries several roots"/>
          <outline text="Localise by motor, sensory, reflex patterns"/>
        </outline>
        <outline text="Nerves need blood supply and gliding">
          <outline text="Compression impairs axonal transport"/>
          <outline text="Entrapment at retinacula and tunnels"/>
        </outline>
        <outline text="Endoneurium, perineurium, epineurium">
          <outline text="Perineurium: blood-nerve barrier"/>
          <outline text="Intrafascicular injury despite continuity"/>
        </outline>
        <outline text="Autonomic fibres follow vessels and nerves"/>
        <outline text="Referred pain from afferent convergence"/>
      </outline>
      <outline text="Lymph and fascial spread">
        <outline text="Superficial with veins, deep with arteries"/>
        <outline text="Blocked routes divert to other basins"/>
        <outline text="Lymphoedema: inadequate lymphatic transport">
          <outline text="Inflammation drives fat and fibrosis"/>
        </outline>
        <outline text="Spread along low-resistance planes">
          <outline text="Deep neck infection to mediastinum"/>
          <outline text="Shaped by gravity, pressure, openings"/>
        </outline>
      </outline>
      <outline text="Muscles as functional compartments">
        <outline text="Shared innervation and broad action"/>
        <outline text="Either attachment can be fixed"/>
        <outline text="Line of pull and moment arm set torque"/>
        <outline text="Agonist, antagonist, synergist, fixator"/>
        <outline text="Eccentric, concentric, isometric contraction"/>
        <outline text="Biarticular muscles cross two joints">
          <outline text="Active insufficiency: too shortened"/>
          <outline text="Passive insufficiency: cannot lengthen enough"/>
        </outline>
        <outline text="Ask what bounds, traverses, communicates"/>
      </outline>
    </outline>
  </body>
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