eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Compartment Syndrome, Extremity: Differential Diagnoses & Workup

Author: Richard Paula, MD, Director of Research, Assistant Professor of Emergency Medicine, University of South Florida
Contributor Information and Disclosures

Updated: Dec 10, 2008

Differential Diagnoses

Cellulitis
Peripheral Vascular Injuries
Coelenterate and Jellyfish Envenomations
Rhabdomyolysis
Deep Venous Thrombosis and Thrombophlebitis
Gas Gangrene
Necrotizing Fasciitis

Other Problems to Be Considered

Differentials listed above often occur concurrently with CS.

Workup

Laboratory Studies

Laboratory results are often normal and are not necessary to diagnose compartment syndrome (CS) and are not helpful to rule out CS.

  • Complete metabolic profile (CMP)
  • Complete blood count (CBC) with differential
  • Creatine phosphokinase (CPK) and urine myoglobin levels
  • Serum myoglobin level
  • Urine toxicology screen: This subsequently may help define the etiology, but it rarely is helpful in patient treatment.
  • Initial urinalysis: This may be positive for blood but negative for RBC on microscopic analysis, which may indicate myoglobin in the urine (rhabdomyolysis).
  • Prothrombin time (PT) and activated partial thromboplastin time (aPTT)

Imaging Studies

  • Radiography of the affected extremity
  • Ultrasonography
    • Ultrasonography aids in evaluating arterial flow as well as in visualizing any deep venous thrombosis (DVT).
    • Ultrasonography is not helpful in diagnosis of CS; however, it aids in the elimination of differential diagnoses.

Other Tests

  • Compartment pressure measurement
    • This measure should be at the top of the list when searching for CS; perform it as soon as the diagnosis of CS is considered.
    • A number of commercial model tonometers are available (eg, Stryker, ACE). A number of "build-it-yourself" techniques, without evidence of reliability, are also available; their use is not recommended.
  • Pulse oximetry
    • Pulse oximetry is helpful in identifying limb hypoperfusion.
    • It is not sensitive enough to exclude compartment syndrome.

More on Compartment Syndrome, Extremity

Overview: Compartment Syndrome, Extremity
Differential Diagnoses & Workup: Compartment Syndrome, Extremity
Treatment & Medication: Compartment Syndrome, Extremity
Follow-up: Compartment Syndrome, Extremity
Multimedia: Compartment Syndrome, Extremity
References
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References

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Further Reading

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Keywords

compartment syndrome extremity, CS, compartmental syndrome, Volkmann contracture, Volkmann's contracture, intracompartmental pressure, extremity pain, perfusion pressure, capillary perfusion pressure, CPP, venous pressure, long bone fractures, vascular injury, ischemic injury, fasciotomy, paraesthesia, limb pain, high-energy trauma, penetrating injuries, venous injury, crush injuries, tetany, vigorous exercise, seizures, stationary bicycle use, horseback riding, burns, intraarterial injection, envenomation, decreased serum osmolarity, nephrotic syndrome, infiltrated infusion, hemorrhage, military antishock trousers, MAST

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Contributor Information and Disclosures

Author

Richard Paula, MD, Director of Research, Assistant Professor of Emergency Medicine, University of South Florida
Richard Paula, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Eric L Legome, MD, Chair, Department of Emergency Medicine, St Vincent's Hospital Manhattan; 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.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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