Key learning

  • Commonly due to lower limb trauma/surgery/crush injuries
  • Present with pain disproportionate to injury, tense compartments and paraesthesia
  • Pain with passive stretch of affected muscles
  • Clinical diagnosis
  • Compartment pressure measurement with manometry can aid diagnosis (>40mmHg diagnostic)
  • Definitive management is open fasciotomy

Pathophysiology

  • Increased pressure within a muscle compartment leads to compromised tissue perfusion and nerve function

Causes

  • Commonly due to trauma, including fractures, crush injuries, or muscle overuse. 
  • Other causes include:
    • Ischemia-reperfusion injury
    • Burns
    • Vascular injuries
    • Bleeding disorders
    • Prolonged limb compression
    • Tight bandages

Clinical Features

  • Commonly in lower limb
  • Classically severe pain disproportionate to injury
  • Tightness
  • Paraesthesia

Examination Findings

  • Tense compartments
  • Decreased sensation- particularly first web space of foot
  • Diminished pulses, and pallor or cyanosis. 
  • Pain with passive stretch of affected muscles
  • Severe cases:
    • Paralysis 
    • Absent pulses.

Investigations

  • Diagnosis is primarily clinical- Delayed diagnosis can lead to irreversible tissue damage.
  • Measurement of compartment pressures with a handheld manometer can aid diagnosis (> 40mmHg = diagnostic)
  • Imaging (MRI or CT) helps identify underlying causes. 

Management 

Initial

  • Elevation
  • Analgesia
  • Avoid tight dressings

Definitive 

  • Immediate decompression via open fasciotomy 

Complications

  • Myoglobinuria
  • Nerve damage
  • Renal damage
  • Limb loss

Useful links

British Orthopaedic Association- Compartment Syndrome