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Compartment Syndrome Evaluation

  • Editor(s): Todd W Thomsen, MD, Gary S Setnik, MD, FACEP
  • Section Editor(s): Phillip M Harter, MD
  • Contributor(s): Carmie Chan, MD
PRE-PROCEDURE
INDICATIONS
  • Suspected compartment syndrome
  • Abnormal tissue pressures
  • A history that suggests possible compartment syndrome
  • Abnormal physical exam that suggests compartment syndrome
  • Table 1 lists the signs and symptoms of the respective compartments when compartment syndromeis suspected.
CONTRAINDICATIONS
  • There are no absolute contraindications to performing compartment pressure measurements or continuous pressure monitoring. Use caution in patients with platelet dysfunction or other coagulation disorders.
  • If possible, needle insertion should be avoided in areas of cellulitis, infection, or burns.
EQUIPMENT
  • Stryker 295-2 Quick Pressure Monitor Set (disposable pouch)
  • Stryker handheld pressure monitoring unit (included in the Stryker Set)
  • 1 3-mL syringe prefilled with saline (included in the Stryker Set)
  • 1 side-port needle (included in the Stryker Set)
  • 1 diaphragm chamber (included in the Stryker Set)
  • Sterile gauze
  • Skin antiseptic
  • Supplies for anesthetic administration
    • 1% lidocaine
    • 5-mL syringe
    • 25-gauge needle
ANATOMY
  • Forearm compartments
    • The volar forearm compartment
    • Dorsal forearm compartment
    • The “mobile wad” compartment
  • Lower leg compartments
    • Anterior lower leg compartment
    • Lateral lower leg compartment
    • The deep posterior lower leg compartment
    • Superficial posterior lower leg compartment
  • Foot compartments
    • There are nine compartments, separated into four groups: the central/calcaneal, intrinsic/interosseous, medial, and lateral groups.
  • Gluteal region
    • The fascia divides the musculature into three distinct compartments: maximus, tensor, and medius/minimus.
Severely contused and edematous foot; this patient may have compartment syndrome.
Figure 3 :  Severely contused and edematous foot; this patient may have compartment syndrome.

Table 1 : 

Stryker Pressure Monitor.
Figure 5 :  Stryker Pressure Monitor.

Forearm compartments.
Figure 7 :  Forearm compartments.

Anterior and lateral lower leg compartments.
Figure 8 :  Anterior and lateral lower leg compartments.


PROCEDURE
Sample excerpt does not include step-by-step text instructions for performing this procedure
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures
Anesthetize the skin with a small amount of anesthetic.
Figure 14 :  Anesthetize the skin with a small amount of anesthetic.

After assembling the needle, diaphragm chamber, and syringe, place it into the Pressure Monitor.
Figure 15 :  After assembling the needle, diaphragm chamber, and syringe, place it into the Pressure Monitor.

Hold the device at the intended angle of insertion, and press the “zero” button.
Figure 16 :  Hold the device at the intended angle of insertion, and press the “zero” button.

Proper needle position for the anterior compartment.
Figure 17 :  Proper needle position for the anterior compartment.

Proper needle position for the deep posterior compartment.
Figure 18 :  Proper needle position for the deep posterior compartment.

Proper needle position for the lateral compartment.
Figure 19 :  Proper needle position for the lateral compartment.

Proper needle position for the superficial posterior compartment.
Figure 20 :  Proper needle position for the superficial posterior compartment.

Proper needle position for the volar compartment.
Figure 21 :  Proper needle position for the volar compartment.

Proper needle position for the dorsal compartment.
Figure 22 :  Proper needle position for the dorsal compartment.

Proper needle position for the mobile wad compartment.
Figure 23 :  Proper needle position for the mobile wad compartment.

For the gluteal compartments, insert the needle in the region of maximal tenderness.
Figure 24 :  For the gluteal compartments, insert the needle in the region of maximal tenderness.

Proper needle position for the medial compartment.
Figure 25 :  Proper needle position for the medial compartment.

Proper needle position for the central compartment. Note that the entry site is the same as for the medial compartment; however, the needle is advanced to a depth of 3 cm.
Figure 26 :  Proper needle position for the central compartment. Note that the entry site is the same as for the medial compartment; however, the needle is advanced to a depth of 3 cm.

Proper needle position for the lateral compartment.
Figure 27 :  Proper needle position for the lateral compartment.

Proper needle position for the intrinsic compartments.
Figure 28 :  Proper needle position for the intrinsic compartments.


POST-PROCEDURE
CARE
  • Fasciotomy
    • Details of the procedure are beyond the scope of this chapter.
  • In addition to surgical intervention (fasciotomy), physiologic support is paramount.
    • Support blood pressures.
    • Remove sources of external pressure, if appropriate.
COMPLICATIONS
  • Infection
  • Pain
RESULT ANALYSIS
  • There is no consensus on the threshold at which a fasciotomy should be performed. Some authors argue an absolute compartment pressure of ≥30 mm Hg as the threshold. But others have reported patients with pressures <45 mm Hg with no signs or symptoms consistent with compartment syndrome, whereas those with pressures >60 mm Hg were symptomatic.1
  • Some authors relate the pressure threshold to blood pressure.
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