Evaluation

There are frequently delays in diagnosis of compartment syndrome secondary to head injuries, level of consciousness, and other musculoskeletal injuries that may mask the symptoms. Therefore, there must be a high index of suspicion for compartment syndrome in evaluating polytrauma patients.

On exam, the compartment will be tense to palpation. The skin is often tight with a shiny appearance. The hallmark finding in compartment syndrome is pain disproportionate to that expected for the injury or to exam. Pain with passive stretch of the muscles in the compartment in question is a reliable indicator.1 Late findings include paralysis (muscle weakness), pallor, and paresthesia. Pulses are often strong even in florid, acute compartment syndrome and therefore are not a reliable sign to help guide treatment options.1

Compartment pressures can be measured in a variety of ways and several different thresholds for fasciotomy from direct compartment pressure to a difference between diastolic and compartment pressure have been described. A commonly accepted threshold is compartment pressure of 30-35 mm Hg.

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