Acute Compartment Syndrome Clinical Presentation

  • Author: Abraham T Rasul Jr, MD; Chief Editor: Consuelo T Lorenzo, MD   more...
 
Updated: Nov 11, 2011
 

History

Patients with compartment syndrome typically present with pain whose severity appears out of proportion to the injury. The pain is often described as burning. The pain is also deep and aching in nature and is worsened by passive stretching of the involved muscles. The patient may describe a tense feeling in the extremity. Pain, however, should not be a sine qua non of the diagnosis. In severe trauma, such as an open fracture, it is difficult to differentiate between pain from the fracture and pain resulting from increased compartment pressure.

Paresthesia or numbness is an unreliable early complaint[10] ; however, decreased 2-point discrimination is a more reliable early test and can be helpful to make the diagnosis. Botte and Gelberman reported that 4 of 9 awake patients with compartment pressures higher than 30 mm Hg had median nerve 2-point discrimination of more than 1 cm.[15] Correlation has also been reported between diminished vibration sense (256 cycles/s) and increasing compartment pressure. Importantly, note that these symptoms assume a conscious patient who did not suffer any additional injury that hinders sensory input (eg, spinal cord injury). In young children, the ability to gather a history of complaints is limited.

Determine the mechanism of injury. High-velocity injuries are particularly worrisome, as are long-bone fractures and crush injuries. Penetrating injuries (eg, gunshot wounds, stabbings) can cause arterial injury, which can quickly lead to compartment syndrome. Venous injury may also cause compartment syndrome, however, so the clinician should not be misled by the presence of palpable pulses.

Anticoagulation therapy and bleeding disorders (eg, hemophilia) significantly increase the likelihood of compartment syndrome. Remember to ask if patients are anticoagulated for any reason. Compartment syndrome requiring fasciotomy has been observed after simple venipuncture in an anticoagulated patient.

Vigorous exertion may lead to compartment syndrome. Compartment syndrome has been found in soldiers and athletes without any trauma. This can be acute or chronic, with acute compartment pressures as high as those found in severe trauma. If compartment syndrome is suspected, check intracompartmental pressure, even in the absence of any trauma history.[46]

Hand compartment syndrome

Compartment syndrome in the hand most often occurs following iatrogenic injury in a patient who is obtunded in an intensive care unit. Symptoms may be nonspecific when compared with those in other cases of compartment syndrome. Early recognition of this complication is based on physical examination and a high index of suspicion. Compartment syndrome in the hand, unlike cases elsewhere in the body, does not cause abnormalities in the sensory nerves, as no nerves are found within the compartments.

Consider the diagnosis when nonspecific aching of the hand, increased pain, loss of digital motion, and continued swelling are present. A tight, swollen hand in an intrinsic minus position—with the digits in metacarpophalangeal (MCP) extension and proximal interphalangeal (PIP) flexion—is highly indicative. Intrinsic tightness becomes evident on examination because motion of the PIP joint becomes dependent on the position of the MCP joint (more PIP motion is possible with MCP flexion than with MCP extension).

Next

Physical Examination

On physical examination, evidence of trauma and gross deformity should alert the physician to the possibility of a developing compartment syndrome. Comparison of the affected limb to the unaffected limb is useful. Excessively vigorous examination of a tibial fracture should be avoided because this may exacerbate irritation of the deep posterior compartment.

Common symptoms observed in compartment syndrome include a feeling of tightness and swelling. Pain with certain movements, particularly passive stretching of the muscles, is the earliest clinical indicator of compartment syndrome. A patient may report pain with active flexion.

The traditional 5 P's of acute ischemia in a limb (ie, pain, paresthesia, pallor, pulselessness, poikilothermia) are not clinically reliable; they may manifest only in the late stages of compartment syndrome, by which time extensive and irreversible soft tissue damage may have taken place. Peripheral pulses and capillary refill remain normal in most cases of upper extremity acute compartment syndrome.

The most important diagnostic physical finding is a firm, wooden feeling on deep palpation. Bullae may also be seen; however, so-called fracture blisters are common in the absence of compartment syndrome. In cases involving the leg, a soft tissue mass may be noticed as a result of herniation of fat and/or muscle tissue from the fascial defect that is often found in the lower third of the leg. In cases of trauma and gross deformity, a claw-toe deformity might occur; therefore, the patient should be evaluated for such a condition.

If a patient complains of pain, determine whether any neural compromise is present. Sensory nerves tend to be affected before the motor nerves, and selected nerves may be more susceptible than others in the same compartment. For example, in acute anterior lower leg compartment syndrome, the first sign to develop may be numbness between the first 2 toes (superficial peroneal nerve).

Decreased 2-point discrimination is the most consistent early finding, and correlation has also been reported between diminished vibration sense (as measured with a 256 cycle per second tuning fork). If objective evidence of a major sensory deficit, a motor deficit, or loss of peripheral pulse is found, the syndrome is far advanced.

Previous
Proceed to Differential Diagnoses
 
 
Contributor Information and Disclosures
Author

Abraham T Rasul Jr, MD  Medical Director for Rehabilitation, Specialty Hospital of Washington; Founder, Arizona Golf Medicine Institute

Abraham T Rasul Jr, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD  Physiatrist, Department of Physical Medicine and Rehabilitation, Alegent Health, Immanuel Rehabilitation Center

Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford University Medical Center

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard Paula, MD Assistant Professor of Emergency Medicine, Director of Research, University of South Florida College of Medicine

Richard Paula, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Steven I Rabin, MD Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Douglas G Smith, MD Associate Professor, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Jeffrey L Visotsky, MD Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Stephen Wallace, MD Staff Physician, Department of Emergency Medicine, Memorial Hospital of Sweetwater County

Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Additional Contributors

Samuel Agnew, MD, FACS Associate Professor, Departments of Orthopedic Surgery and Surgery, Chief of Orthopedic Trauma, University of Florida at Jacksonville College of Medicine; Consulting Surgeon, Department of Orthopedic Surgery, McLeod Regional Medical Center

Samuel Agnew, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, Orthopaedic Trauma Association, and Southern Orthopaedic Association

Disclosure: Nothing to disclose.

Jason H Calhoun, MD, FACS Frank J Kloenne Chair in Orthopedic Surgery, Professor and Chair, Department of Orthopedics, The Ohio State University Medical Center

Jason H Calhoun, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Diabetes Association, American Medical Association, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Missouri State Medical Association, Musculoskeletal Infection Society, Southern Medical Association, Southern Orthopaedic Association, Texas Medical Association, and Texas Orthopaedic Association

Disclosure: Nothing to disclose.

William K Chiang, MD Associate Professor, Department of Emergency Medicine, New York University School of Medicine; Chief of Service, Department of Emergency Medicine, Bellevue Hospital Center

William K Chiang, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Medical Toxicology, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Patrick M Foye, MD Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain Service (Tailbone Pain Service: www.TailboneDoctor.com), University of Medicine and Dentistry of New Jersey, New Jersey Medical School

Patrick M Foye, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society

Disclosure: Nothing to disclose.

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE Robert L and Mary Ellenburg Professor of Surgery, Professor, Department of Orthopedic Surgery, Fellowship Director, Orthopedic Adult Reconstruction, Affiliated Faculty, Department of Bioengineering, Affiliated Faculty, Stanford Center on Longevity, Stanford University School of Medicine, Stanford University Medical Center

Stuart B Goodman, MD, PhD, FRCS(C), FACS, FBSE is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, California Medical Association, Canadian Medical Association, College of Physicians and Surgeons of Ontario, Orthopaedic Trauma Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Mary Ann E Keenan, MD Professor, Vice Chair for Graduate Medical Education, Department of Orthopedic Surgery, University of Pennsylvania School of Medicine; Chief of Neuro-Orthopedics Program, Department of Orthopedic Surgery, Hospital of the University of Pennsylvania

Mary Ann E Keenan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, American Society for Surgery of the Hand, and Orthopaedic Rehabilitation Association

Disclosure: Nothing to disclose.

Rick Kulkarni, MD

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Eric L Legome, MD Chief, Department of Emergency Medicine, Kings County Hospital Center; Associate Professor, Department of Emergency Medicine, New York Medical College

Eric L Legome, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Richard Paula, MD Assistant Professor of Emergency Medicine, Director of Research, University of South Florida College of Medicine

Richard Paula, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Steven I Rabin, MD Clinical Associate Professor, Loyola University Medical Center; Chair, Department of Orthopedic Surgery, Dreyer Medical Clinic

Steven I Rabin, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Fracture Association, AO Foundation, and Orthopaedic Trauma Association

Disclosure: Nothing to disclose.

Douglas G Smith, MD Associate Professor, Department of Orthopedic Surgery, Harborview Medical Center, University of Washington School of Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: eMedicine Salary Employment

Jeffrey L Visotsky, MD Assistant Professor, Department of Clinical Orthopedic Surgery, Northwestern University, The Feinberg School of Medicine

Jeffrey L Visotsky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American College of Physician Executives, American College of Surgeons, American Medical Association, American Society for Surgery of the Hand, Arthroscopy Association of North America, Chicago Medical Society, and Illinois State Medical Society

Disclosure: Depuy Consulting fee Speaking and teaching; Pegasus Honoraria Board membership

Stephen Wallace, MD Staff Physician, Department of Emergency Medicine, Memorial Hospital of Sweetwater County

Stephen Wallace, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Rajesh R Yadav, MD Associate Professor, Section of Physical Medicine and Rehabilitation, MD Anderson Cancer Center, University of Texas Medical School at Houston

Rajesh R Yadav, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

References

  1. Claes T, Van der Beek D, Claes S, Verfaillie S, Bataillie F. Chronic exertional compartment syndrome of the forearm in motocross racers. Presented at: The European Sports Medicine Congress; Hasselt, Belgium; May 14-16, 2003. [Full Text].

  2. Goubier JN, Saillant G. Chronic compartment syndrome of the forearm in competitive motor cyclists: a report of two cases. Br J Sports Med. 2003;37(5):452-3; discussion 453-4. [Medline]. [Full Text].

  3. Piasecki DP, Meyer D, Bach BR Jr. Exertional compartment syndrome of the forearm in an elite flatwater sprint kayaker. Am J Sports Med. Nov 2008;36(11):2222-5. [Medline].

  4. Qvarfordt P, Christenson JT, Eklof B, et al. Intramuscular pressure, muscle blood flow, and skeletal muscle metabolism in chronic anterior tibial compartment syndrome. Clin Orthop. Oct 1983;(179):284-90. [Medline].

  5. Bleicher RJ, Sherman HF, Latenser BA. Bilateral gluteal compartment syndrome. J Trauma. Jan 1997;42(1):118-22. [Medline].

  6. Tekwani K, Sikka R. High-risk chief complaints III: abdomen and extremities. Emerg Med Clin North Am. Nov 2009;27(4):747-65, x. [Medline].

  7. von Volkmann R. Veilletzungen und Krankenheiten der Berwegungsorgane. In: von Pithe F, Billroth T. Stuttgart, Verlag von Ferdinand Enke, eds. Handbuch der Allgemeinen und Speziellen Chirurgs. Zweiter Band, Zweiter Abteilung, Abschmitt V, Ersted haft: 1882:234-920.

  8. Jepson PN. Ischaemic contracture: experimental study. Ann Surg. 1926;84:785-95.

  9. Owen CA, Mubarak SJ, Hargens AR, Rutherford L, Garetto LP, Akeson WH. Intramuscular pressures with limb compression clarification of the pathogenesis of the drug-induced muscle-compartment syndrome. N Engl J Med. May 24 1979;300(21):1169-72. [Medline].

  10. Matsen FA 3rd. Compartmental syndrome. An unified concept. Clin Orthop Relat Res. Nov-Dec 1975;8-14. [Medline].

  11. Amendala A, Rorabeck CH. Chronic exertional compartment syndrome. In: Welsh RP, Shepard RJ, eds. Current Therapy in Sports Medicine. 1985. Toronto, Canada: BC Decker; 250-2.

  12. Blackman P, Bradshaw C, Crossley K. Chronic exertional compartment syndrome in the lower leg. A comparison of treatment options and outcome. International Conference of Science and Medicine in Sports, Brisbane, Australia. 1994;56-7.

  13. Blackman PG. A review of chronic exertional compartment syndrome in the lower leg. Med Sci Sports Exerc. Mar 2000;32(3 Suppl):S4-10. [Medline].

  14. Eisele SA, Sammarco GJ. Chronic exertional compartment syndrome. Instr Course Lect. 1993;42:213-7. [Medline].

  15. Howard JL, Mohtadi NG, Wiley JP. Evaluation of outcomes in patients following surgical treatment of chronic exertional compartment syndrome in the leg. Clin J Sport Med. Jul 2000;10(3):176-84. [Medline].

  16. Liem NR, Bourque PR, Michaud C. Acute exertional compartment syndrome in the setting of anabolic steroids: an unusual cause of bilateral footdrop. Muscle Nerve. Jul 2005;32(1):113-7. [Medline].

  17. Mouhsine E, Garofalo R, Moretti B, et al. Two minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. Knee Surg Sports Traumatol Arthrosc. Feb 2006;14(2):193-7. [Medline].

  18. Schepsis AA, Martini D, Corbett M. Surgical management of exertional compartment syndrome of the lower leg. Long-term followup. Am J Sports Med. Nov-Dec 1993;21(6):811-7; discussion 817. [Medline].

  19. Clayton JM, Hayes AC, Barnes RW. Tissue pressure and perfusion in the compartment syndrome. J Surg Res. Apr 1977;22(4):333-9. [Medline].

  20. Shrier I, Magder S. Pressure-flow relationships in in vitro model of compartment syndrome. J Appl Physiol. Jul 1995;79(1):214-21. [Medline].

  21. Beraldo S, Dodds SR. Lower limb acute compartment syndrome after colorectal surgery in prolonged lithotomy position. Dis Colon Rectum. Nov 2006;49(11):1772-80. [Medline].

  22. Walker JL, Smith GH, Gaston MS, Robinson CM. Spontaneous compartment syndrome in association with simvastatin-induced myositis. Emerg Med J. May 2008;25(5):305-6. [Medline].

  23. Detmer DE, Sharpe K, Sufit RL, et al. Chronic compartment syndrome: diagnosis, management, and outcomes. Am J Sports Med. May-Jun 1985;13(3):162-70. [Medline].

  24. Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. Jun 1983;63(3):539-65. [Medline].

  25. King TW, Lerman OZ, Carter JJ, Warren SM. Exertional compartment syndrome of the thigh: a rare diagnosis and literature review. J Emerg Med. Aug 2010;39(2):e93-9. [Medline].

  26. Naidu KS, Chin T, Harris C, Talbot S. Bilateral peroneal compartment syndrome after horse riding. Am J Emerg Med. Sep 2009;27(7):901.e3-5. [Medline].

  27. Malic CC, Hernon C, Austin O, Phipps A. Scalded and swollen-beware the underlying compartment syndrome. Burns. Jun 2006;32(4):504-6. [Medline].

  28. Crick KA, Crick JC, Pulley MT. Hemorrhagic upper extremity complications from tissue plasminogen activator. J Surg Orthop Adv. Spring 2007;16(1):27-30. [Medline].

  29. Wang KL, Li SY, Chuang CL, Chen TW, Chen JY. Subfascial hematoma progressed to arm compartment syndrome due to a nontransposed brachiobasilic fistula. Am J Kidney Dis. Dec 2006;48(6):990-2. [Medline].

  30. Rafiq I, Anderson DJ. Acute rhabdomyolysis following acute compartment syndrome of upper arm. J Coll Physicians Surg Pak. Nov 2006;16(11):734-5. [Medline].

  31. Swaringen JC, Seiler JG 3rd, Bruce RW Jr. Influenza A induced rhabdomyolysis resulting in extensive compartment syndrome. Clin Orthop Relat Res. Jun 2000;243-9. [Medline].

  32. Wirth JJ, Sheka KP, Gheewala A, Rowe NM. Acquired immune deficiency syndrome and systemic lupus erythematosis: potential causes of surgical emergencies of the hand. Ann Plast Surg. Jul 2008;61(1):35-9. [Medline].

  33. Rahm M, Probe R. Extensive deep venous thrombosis resulting in compartment syndrome of the thigh and leg. A case report. J Bone Joint Surg Am. Dec 1994;76(12):1854-7. [Medline].

  34. Aprahamian C, Gessert G, Bandyk DF, Sell L, Stiehl J, Olson DW. MAST-associated compartment syndrome (MACS): a review. J Trauma. May 1989;29(5):549-55. [Medline].

  35. Ashton H. Effect of inflatable plastic splints on blood flow. Br Med J. Dec 10 1966;2(5527):1427-30. [Medline]. [Full Text].

  36. Verdolin MH, Toth AS, Schroeder R. Bilateral lower extremity compartment syndromes following prolonged surgery in the low lithotomy position with serial compression stockings. Anesthesiology. Apr 2000;92(4):1189-91. [Medline].

  37. Dailiana HZ, Kotsaki D, Varitimidis S, et al. Injection injuries: seemingly minor injuries with major consequences. Hippokratia. Jan 2008;12(1):33-6. [Medline]. [Full Text].

  38. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. Jan 1996;78(1):99-104. [Medline]. [Full Text].

  39. DeLee JC, Stiehl JB. Open tibia fracture with compartment syndrome. Clin Orthop Relat Res. Oct 1981;175-84. [Medline].

  40. Feliciano DV, Cruse PA, Spjut-Patrinely V, Burch JM, Mattox KL. Fasciotomy after trauma to the extremities. Am J Surg. Dec 1988;156(6):533-6. [Medline].

  41. Rorabeck CH, Macnab I. The pathophysiology of the anterior tibial compartmental syndrome. Clin Orthop Relat Res. Nov-Dec 1975;52-7. [Medline].

  42. Matsen FA 3rd, Winquist RA, Krugmire RB Jr. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. Mar 1980;62(2):286-91. [Medline].

  43. Sheridan GW, Matsen FA 3rd. Fasciotomy in the treatment of the acute compartment syndrome. J Bone Joint Surg Am. Jan 1976;58(1):112-5. [Medline].

  44. Rockwood CA Jr, Green DP, Bucholz RW, Heckman JD, eds. Rockwood and Green's Fractures in Adults. 4th ed. Philadelphia, Pa: Lippincott-Raven; 1996.

  45. Matsen FA 3rd, Winquist RA, Krugmire RB Jr. Diagnosis and management of compartmental syndromes. J Bone Joint Surg Am. Mar 1980;62(2):286-91. [Medline].

  46. Cincinnati Children's Hospital Medical Center. Evidence-based care guideline for femoral shaft fractures. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; Dec 2006:[Full Text].

  47. Reach JS Jr, Amrami KK, Felmlee JP, et al. The compartments of the foot: a 3-tesla magnetic resonance imaging study with clinical correlates for needle pressure testing. Foot Ankle Int. May 2007;28(5):584-94. [Medline].

  48. Yu JS, Habib P. MR imaging of urgent inflammatory and infectious conditions affecting the soft tissues of the musculoskeletal system. Emerg Radiol. Jan 9 2009;[Medline].

  49. Jones WG 2nd, Perry MO, Bush HL Jr. Changes in tibial venous blood flow in the evolving compartment syndrome. Arch Surg. Jul 1989;124(7):801-4. [Medline].

  50. Mubarak SJ, Hargens AR, Owen CA, Garetto LP, Akeson WH. The wick catheter technique for measurement of intramuscular pressure. A new research and clinical tool. J Bone Joint Surg Am. Oct 1976;58(7):1016-20. [Medline].

  51. Styf J, Wiger P. Abnormally increased intramuscular pressure in human legs: comparison of two experimental models. J Trauma. Jul 1998;45(1):133-9. [Medline].

  52. Matsen FA 3rd, Wyss CR, Krugmire RB Jr, Simmons CW, King RV. The effects of limb elevation and dependency on local arteriovenous gradients in normal human limbs with particular reference to limbs with increased tissue pressure. Clin Orthop Relat Res. Jul-Aug 1980;187-95. [Medline].

  53. Garfin SR, Mubarak SJ, Evans KL, Hargens AR, Akeson WH. Quantification of intracompartmental pressure and volume under plaster casts. J Bone Joint Surg Am. Mar 1981;63(3):449-53. [Medline].

  54. Wallensten R, Karlsson J. Histochemical and metabolic changes in lower leg muscles in exercise- induced pain. Int J Sports Med. Aug 1984;5(4):202-8. [Medline].

  55. Better OS, Zinman C, Reis DN, et al. Hypertonic mannitol ameliorates intracompartmental tamponade in model compartment syndrome in the dog. Nephron. 1991;58(3):344-6. [Medline].

  56. Shah DM, Bock DE, Darling RC 3rd, et al. Beneficial effects of hypertonic mannitol in acute ischemia--reperfusion injuries in humans. Cardiovasc Surg. Feb 1996;4(1):97-100. [Medline].

  57. Daniels M, Reichman J, Brezis M. Mannitol treatment for acute compartment syndrome. Nephron. Aug 1998;79(4):492-3. [Medline].

  58. Pollak AN. Use of negative pressure wound therapy with reticulated open cell foam for lower extremity trauma. J Orthop Trauma. Nov-Dec 2008;22(10 Suppl):S142-5. [Medline].

  59. Brey JM, Castro MD. Salvage of compartment syndrome of the leg and foot. Foot Ankle Clin. Dec 2008;13(4):767-72. [Medline].

  60. McQueen MM, Court-Brown CM. Compartment monitoring in tibial fractures. The pressure threshold for decompression. J Bone Joint Surg Br. Jan 1996;78(1):99-104. [Medline].

  61. Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. Nov-Dec 1975;43-51. [Medline].

  62. Whitesides TE Jr, Haney TC, Harada H, Holmes HE, Morimoto K. A simple method for tissue pressure determination. Arch Surg. Nov 1975;110(11):1311-3. [Medline].

  63. Arato E, Kurthy M, Sinay L, et al. Pathology and diagnostic options of lower limb compartment syndrome. Clin Hemorheol Microcirc. 2009;41(1):1-8. [Medline].

  64. Nillius A, Rööser B. [Acute compartment syndrome in knee arthroscopy]. Lakartidningen. Feb 16 1983;80(7):590. [Medline].

  65. Peek RD, Haynes DW. Compartment syndrome as a complication of arthroscopy. A case report and a study of interstitial pressures. Am J Sports Med. Nov-Dec 1984;12(6):464-8. [Medline].

  66. Fruensgaard S, Holm A. Compartment syndrome complicating arthroscopic surgery: brief report. J Bone Joint Surg Br. Jan 1988;70(1):146-7. [Medline].

  67. Kaper BP, Carr CF, Shirreffs TG. Compartment syndrome after arthroscopic surgery of knee. A report of two cases managed nonoperatively. Am J Sports Med. Jan-Feb 1997;25(1):123-5. [Medline].

  68. Undersea and Hyperbaric Medical Society. June 2003. Indications for hyperbaric oxygen therapy. Available at http://www.uhms.org/Indications/indications.htm. Accessed July 24, 2007.

  69. Wattel F, Mathieu D, Nevière R, Bocquillon N. Acute peripheral ischaemia and compartment syndromes: a role for hyperbaric oxygenation. Anaesthesia. May 1998;53 Suppl 2:63-5. [Medline].

  70. Mar GJ, Barrington MJ, McGuirk BR. Acute compartment syndrome of the lower limb and the effect of postoperative analgesia on diagnosis. Br J Anaesth. Jan 2009;102(1):3-11. [Medline].

  71. Bywaters EG, Beall D. Crush injuries with impairment of renal function. 1941. J Am Soc Nephrol. Feb 1998;9(2):322-32. [Medline].

  72. Hutchinson MR, Ireland ML. Common compartment syndromes in athletes. Treatment and rehabilitation. Sports Med. Mar 1994;17(3):200-8. [Medline].

 
Previous
Next
 
(Click Image to enlarge.) Volar release in the forearm. The upper illustration shows the incision that is used. The lower left picture depicts the relevant incisional anatomy. The lower right picture depicts the cross-sectional anatomy.
Surgical anatomy of the volar forearm. Photo courtesy of Dr. Smith, Harborview/UW Medical Center, Department of Orthopaedics, Seattle, Wash.
(Click Image to enlarge.) Two-incision anterolateral fasciotomy. Photographs courtesy of DG Smith, MD, Harborview Hospital, Seattle, WA.
(Click Image to enlarge.) Two-incision posteromedial fasciotomy. Photographs courtesy of DG Smith, MD, Department of Orthopedics, Harborview Hospital, Seattle, WA.
(Click Image to enlarge.) Single-incision fasciotomy. Photographs courtesy of DG Smith, MD, Harborview Hospital, Seattle, WA.
Picture of compartment pressure measuring device for use when commercial devices are unavailable.
Stryker STIC Monitor. Image courtesy of Stryker Corporation, used with permission.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.