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.
- ▪ Interstitial pressure: The pressure in the tissue
(typically muscle) in a compartment
- ▪ Indications for testing:
- —Crush injury
- —Bone fracture
- —Vascular injury
- —Extravasation of drug or intravenous fluid infusion
- —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.
Graphic showing compartment measurement
using an ad hoc setup.
Compartment pressure measurement with a commercial tonometer.
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.
Kostler W, Strohm PC, Sudkamp NP. Acute compartment syndrome
of the limb. Injury
. 2005;36: 992–998.