Chapter 52. Diagnosis of Compartment Syndrome

Introduction

Compartment syndrome is an acute process wherein increased pressure in a muscle compartment with a confining fascial compartment leads to ischemia, muscle and nerve damage.

Definitions and Terms

• ▪  Interstitial pressure: The pressure in the tissue (typically muscle) in a compartment

Techniques

• ▪  Indications for testing:
  • —Crush injury
  • —Bone fracture
  • —Vascular injury
  • —Hemorrhage
  • —Burns
  • —Extravasation of drug or intravenous fluid infusion into compartment
  • —Envenomation
  • —Excess exercise (ie, running, marching)
  • —Casting (ie, after fracture)
• ▪  Method:
  • —Insert needle attached to transducer into compartment(s) of interest using ad hoc (Figure 52-1) or commercial (Figure 52-2) monitor.
  • —Ultrasound may be used to evaluate arterial inflow into a compartment as an adjunct test.
• ▪  Tissue pressure greater than 45 mm Hg or within 30 mm Hg of diastolic blood pressure, when accompanied by signs or symptoms of compartment syndrome (ie, pain, paresthesia, weakness, palpable compartment rigidity), is consistent with compartment syndrome and warrants consideration of fasciotomy.

Clinical Pearls and Pitfalls

• ▪  A high index of suspicion should be maintained in unconscious patients in correct setting and compartment pressure monitored particularly in at-risk compartments in the limbs.

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