Compartment syndrome - Revision history

Danbot: Strip excess bold

2026-03-22T09:31:22Z

Strip excess bold

← Older revision		Revision as of 09:31, 22 March 2026
Line 2:		Line 2:
	*Increased pressure within a closed fascial compartment compromising perfusion to muscles and nerves		*Increased pressure within a closed fascial compartment compromising perfusion to muscles and nerves
	*'''Surgical emergency''' — irreversible damage begins within '''6-8 hours''' of ischemia		*'''Surgical emergency''' — irreversible damage begins within '''6-8 hours''' of ischemia
	*Most common location: ~~'''~~anterior compartment of the leg~~'''~~ (tibia fractures)		*Most common location: anterior compartment of the leg (tibia fractures)
	*Causes:		*Causes:
	**~~'''~~Fractures~~'''~~ (most common — especially tibia, forearm, supracondylar humerus in children)		**Fractures (most common — especially tibia, forearm, supracondylar humerus in children)
	**Crush injuries, reperfusion injury after vascular repair		**Crush injuries, reperfusion injury after vascular repair
	**Burns (circumferential), tight casts/splints/dressings		**Burns (circumferential), tight casts/splints/dressings
Line 11:		Line 11:
	**IV/IO infiltration		**IV/IO infiltration
	*Normal tissue pressure: 0-8 mmHg		*Normal tissue pressure: 0-8 mmHg
	*~~'''~~Ischemia begins when compartment pressure exceeds capillary perfusion pressure~~'''~~		*Ischemia begins when compartment pressure exceeds capillary perfusion pressure

	==Clinical Features==		==Clinical Features==
	*~~'''~~The 6 P's~~'''~~ (pain is earliest and most reliable; pulselessness is latest):		*The 6 P's (pain is earliest and most reliable; pulselessness is latest):
	**~~'''~~Pain~~'''~~ — ~~'''~~out of proportion to exam~~'''~~ (most sensitive early finding)		**Pain — out of proportion to exam (most sensitive early finding)
	**~~'''~~Pain with passive stretch~~'''~~ of muscles in affected compartment (most sensitive exam finding)		**Pain with passive stretch of muscles in affected compartment (most sensitive exam finding)
	**~~'''~~Pressure~~'''~~ — tense, firm compartment on palpation		**Pressure — tense, firm compartment on palpation
	**~~'''~~Paresthesias~~'''~~ — indicates nerve ischemia		**Paresthesias — indicates nerve ischemia
	**~~'''~~Paralysis~~'''~~ — late finding; indicates significant ischemia		**Paralysis — late finding; indicates significant ischemia
	**~~'''~~Pulselessness~~'''~~ — ~~'''~~very late finding~~'''~~; presence of pulses does NOT exclude compartment syndrome		**Pulselessness — very late finding; presence of pulses does NOT exclude compartment syndrome
	*~~'''~~Key pearls~~'''~~:		*Key pearls:
	**~~'''~~Increasing analgesic requirements~~'''~~ should raise suspicion		**Increasing analgesic requirements should raise suspicion
	**Normal pulses and capillary refill do NOT rule out compartment syndrome		**Normal pulses and capillary refill do NOT rule out compartment syndrome
	**'''Obtunded, intubated, or pediatric patients''' cannot report pain — maintain '''high index of suspicion'''		**'''Obtunded, intubated, or pediatric patients''' cannot report pain — maintain '''high index of suspicion'''
Line 37:		Line 37:
	==Evaluation==		==Evaluation==
	===Clinical Diagnosis===		===Clinical Diagnosis===
	*~~'''~~Compartment syndrome is primarily a CLINICAL diagnosis~~'''~~		*Compartment syndrome is primarily a CLINICAL diagnosis
	*Serial examinations are essential		*Serial examinations are essential
	*'''Do not delay fasciotomy for pressure measurement''' if clinical picture is clear		*'''Do not delay fasciotomy for pressure measurement''' if clinical picture is clear

	===Compartment Pressure Measurement===		===Compartment Pressure Measurement===
	*~~'''~~Indicated when clinical exam is unreliable~~'''~~ (obtunded, pediatric, equivocal exam)		*Indicated when clinical exam is unreliable (obtunded, pediatric, equivocal exam)
	*Methods: Stryker needle (most common in ED), arterial line transducer		*Methods: Stryker needle (most common in ED), arterial line transducer
	*~~'''~~Absolute pressure >30 mmHg~~'''~~: concerning		*Absolute pressure >30 mmHg: concerning
	*~~'''~~Delta pressure~~'''~~ (diastolic BP minus compartment pressure) ~~'''~~<30 mmHg~~'''~~: indicates need for fasciotomy<ref>McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures: the pressure threshold for decompression. ''J Bone Joint Surg Br''. 1996;78(1):99-104. PMID 8898137</ref>		*Delta pressure (diastolic BP minus compartment pressure) <30 mmHg: indicates need for fasciotomy<ref>McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures: the pressure threshold for decompression. ''J Bone Joint Surg Br''. 1996;78(1):99-104. PMID 8898137</ref>
	*'''Delta pressure is more reliable than absolute pressure''' (accounts for patient's perfusion status)		*'''Delta pressure is more reliable than absolute pressure''' (accounts for patient's perfusion status)
	*Measure ~~'''~~all compartments~~'''~~ in the affected extremity (leg has 4: anterior, lateral, deep posterior, superficial posterior)		*Measure all compartments in the affected extremity (leg has 4: anterior, lateral, deep posterior, superficial posterior)

	===Labs===		===Labs===
Line 57:		Line 57:
	===Immediate===		===Immediate===
	*'''Remove all circumferential dressings, casts, and splints''' immediately		*'''Remove all circumferential dressings, casts, and splints''' immediately
	*Keep extremity ~~'''~~at heart level~~'''~~ (elevation may decrease arterial perfusion; dependent position worsens edema)		*Keep extremity at heart level (elevation may decrease arterial perfusion; dependent position worsens edema)
	*~~'''~~Avoid hypotension~~'''~~ — maintain adequate perfusion pressure		*Avoid hypotension — maintain adequate perfusion pressure
	*~~'''~~IV fluid resuscitation~~'''~~ if rhabdomyolysis		*IV fluid resuscitation if rhabdomyolysis

	===Fasciotomy===		===Fasciotomy===
	*~~'''~~Definitive treatment~~'''~~ — ~~'''~~emergent surgical consultation~~'''~~		*Definitive treatment — emergent surgical consultation
	*~~'''~~Four-compartment fasciotomy~~'''~~ for lower leg		*Four-compartment fasciotomy for lower leg
	*Delay >6-8 hours: significantly increased risk of permanent neuromuscular damage, amputation		*Delay >6-8 hours: significantly increased risk of permanent neuromuscular damage, amputation
	*'''Do NOT delay for imaging''' if diagnosis is clinically apparent		*'''Do NOT delay for imaging''' if diagnosis is clinically apparent
Line 74:		Line 74:

	==Disposition==		==Disposition==
	*~~'''~~All suspected cases require admission~~'''~~ and ~~'''~~emergent orthopedic/surgical consultation~~'''~~		*All suspected cases require admission and emergent orthopedic/surgical consultation
	*ICU if [[rhabdomyolysis]] or hemodynamic instability		*ICU if [[rhabdomyolysis]] or hemodynamic instability
	*~~'''~~Missed compartment syndrome~~'''~~ is a significant medicolegal risk		*Missed compartment syndrome is a significant medicolegal risk

	==See Also==		==See Also==

Danbot: Major update: delta pressure criteria, 6 Ps with clinical pearls, fasciotomy timing, obtunded patient considerations, medicolegal note, references with PMIDs

2026-03-21T19:45:59Z

Major update: delta pressure criteria, 6 Ps with clinical pearls, fasciotomy timing, obtunded patient considerations, medicolegal note, references with PMIDs

Show changes

Lyssa1219: /* Etiologies */

2020-04-09T21:45:13Z

Etiologies

← Older revision		Revision as of 21:45, 9 April 2020
Line 14:		Line 14:
	*Vascular		*Vascular
	**Ischemic-reperfusion injury		**Ischemic-reperfusion injury
	**Hemorrhage		**Hemorrhage
			***Can be spontaneous in anticoagulated patients
	*Iatrogenic		*Iatrogenic
	**Vascular puncture in anticoagulated patients		**Vascular puncture in anticoagulated patients
Line 24:		Line 25:
	**[[Burn]]		**[[Burn]]
	**[[Snake bite]]		**[[Snake bite]]
			**Expanding hematoma

	==Clinical Features==		==Clinical Features==
Line 37:		Line 39:
	#Pain (early finding)		#Pain (early finding)
	#*Severe, out of proportion to physical findings		#*Severe, out of proportion to physical findings
	#*Worse with passive ~~movement~~ (muscle extension > increased volume > increased pressure)		#*Worse with passive stretch of distal body part such as toes or fingers (muscle extension > increased volume > increased pressure)
	#*Often the presenting symptom.		#*Often the presenting symptom.
	#Paresthesia (early finding)		#Paresthesia (early finding)

Rossdonaldson1: /* Evaluation */

2019-10-22T21:29:22Z

Evaluation

← Older revision		Revision as of 21:29, 22 October 2019
Line 140:		Line 140:
	*Chemistry ([[hyperkalemia]])		*Chemistry ([[hyperkalemia]])

	~~===[[Compartment Pressure Measurement\|Measure Compartment Pressure]]===~~
	{{Compartment Pressure Interpretation}}		{{Compartment Pressure Interpretation}}

Rossdonaldson1: /* Work-Up */

2019-10-22T21:26:34Z

Work-Up

← Older revision		Revision as of 21:26, 22 October 2019
Line 135:		Line 135:
	==Evaluation==		==Evaluation==
	===Work-Up===		===Work-Up===
	*~~xray~~ to ~~rule out~~ fracture		*X-ray to evaluate for fracture
	*Compartment pressure (~~see below;~~ take serial measurements if needed)		*[[Compartment pressure measurement]] (take serial measurements if needed)
	*Total CK~~, UA~~ ([[rhabdomyolysis]])		*Total CK ([[rhabdomyolysis]])
	*Chemistry ([[hyperkalemia]])		*Chemistry ([[hyperkalemia]])

Rossdonaldson1 at 21:22, 22 October 2019

2019-10-22T21:22:07Z

← Older revision		Revision as of 21:22, 22 October 2019
Line 120:		Line 120:
	***CT is less helpful, but can exclude other causes of low-back pain such as fracture		***CT is less helpful, but can exclude other causes of low-back pain such as fracture
	*Treatment is with emergent fasciotomy and with fluid resuscitation for any concurrent rhabdomyolysis <ref>Alexander W. et al. Acute lumbar paraspinal compartment syndrome: a systematic review. ANZ Journal of Surgery. 2018; 88: 854-859.</ref>		*Treatment is with emergent fasciotomy and with fluid resuscitation for any concurrent rhabdomyolysis <ref>Alexander W. et al. Acute lumbar paraspinal compartment syndrome: a systematic review. ANZ Journal of Surgery. 2018; 88: 854-859.</ref>
	[[File:~~MRI_Lumbar_Paraspinal_Compartment_Syndrome~~.png\|thumb\|Magnetic resonance imaging (T1-weighted with gadolinium) showing edema and high signal intensity (arrows) in the region of the left multifidus and longissimus muscles.]]		[[File:MRI Lumbar Paraspinal Compartment Syndrome.png\|thumb\|Magnetic resonance imaging (T1-weighted with gadolinium) showing edema and high signal intensity (arrows) in the region of the left multifidus and longissimus muscles.]]

	===Other===		===Other===
Line 154:		Line 154:
	#Adequate analgesia		#Adequate analgesia
	#Management for associated [[rhabdomyolysis]] if present		#Management for associated [[rhabdomyolysis]] if present

			==Disposition==
			*Admit

	==See Also==		==See Also==

T.Boardman: /* Lumbar Paraspinal */

2019-09-30T21:20:56Z

Lumbar Paraspinal

← Older revision		Revision as of 21:20, 30 September 2019
Line 120:		Line 120:
	***CT is less helpful, but can exclude other causes of low-back pain such as fracture		***CT is less helpful, but can exclude other causes of low-back pain such as fracture
	*Treatment is with emergent fasciotomy and with fluid resuscitation for any concurrent rhabdomyolysis <ref>Alexander W. et al. Acute lumbar paraspinal compartment syndrome: a systematic review. ANZ Journal of Surgery. 2018; 88: 854-859.</ref>		*Treatment is with emergent fasciotomy and with fluid resuscitation for any concurrent rhabdomyolysis <ref>Alexander W. et al. Acute lumbar paraspinal compartment syndrome: a systematic review. ANZ Journal of Surgery. 2018; 88: 854-859.</ref>
	[[File:~~MRI Lumbar Paraspinal Compartment Syndrome~~.png\|thumb\|Magnetic resonance imaging (T1-weighted with gadolinium) showing edema and high signal intensity (arrows) in the region of the left multifidus and longissimus muscles.]]		[[File:MRI_Lumbar_Paraspinal_Compartment_Syndrome.png\|thumb\|Magnetic resonance imaging (T1-weighted with gadolinium) showing edema and high signal intensity (arrows) in the region of the left multifidus and longissimus muscles.]]

	===Other===		===Other===

T.Boardman: /* Other */

2019-09-24T15:38:25Z

Other

@@ Line 97: / Line 97: @@
 ***SCDs may help decrease interstitial pressure, improve venous return/arterial flow
 ***Fasciotomy within 24 hrs of injury if pressures > 30 mmHg
 ===Other===
@@ Line 128: / Line 152: @@
 #AVOID ice (will further compromise microcirculation)
 #Bivalve or remove cast if present
-#Adequate [[analgesia]]
+#Adequate analgesia
 #Management for associated [[rhabdomyolysis]] if present

ClaireLewis: /* Management */

2019-09-24T03:42:09Z

Management

← Older revision		Revision as of 03:42, 24 September 2019
Line 128:		Line 128:
	#AVOID ice (will further compromise microcirculation)		#AVOID ice (will further compromise microcirculation)
	#Bivalve or remove cast if present		#Bivalve or remove cast if present
	#Adequate analgesia		#Adequate [[analgesia]]
	#Management for associated [[rhabdomyolysis]] if present		#Management for associated [[rhabdomyolysis]] if present

Rossdonaldson1: /* Differential Diagnosis */

2019-08-13T07:01:20Z

Differential Diagnosis

← Older revision		Revision as of 07:01, 13 August 2019
Line 107:		Line 107:
	==Differential Diagnosis==		==Differential Diagnosis==
	{{Extremity trauma DDX}}		{{Extremity trauma DDX}}

	{{Calf pain DDX}}		{{Calf pain DDX}}