Compartment Syndrome

  • Medical Author:
    Benjamin Wedro, MD, FACEP, FAAEM

    Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

  • Medical Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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What are the symptoms and signs of compartment syndrome?

The symptoms of compartment syndrome, plus the circumstances that led to their development assist to make the clinical diagnosis. Pain out of proportion to the injury (or physical examination of the muscle compartment) often is the clue to make the diagnosis of compartment syndrome. Increased pressure within the muscle compartment causes loss of blood supply and nerve inflammation. This causes significant pain and numbness or paresthesia. (para=abnormal + ethesia=feeling).

The diagnosis should be always considered when there is either an associated fracture, high velocity injury like a gunshot wound or a crush injury. Individuals who are taking anticoagulant medications such as warfarin (Coumadin) or enoxaparin (Lovenox) are at higher risk for bleeding into a compartment spontaneously or after injury.

Historically, the mnemonic memory device for compartment syndrome is the "5 Ps" (pain, paresthesia [change in sensation], pallor [pale coloration], paralysis, and poikilothermia [inability to control temperature]; some authors include pulselessness), but this should not be relied upon to make a diagnosis. Only pain and change in sensation (parathesia) may be symptoms that point to the diagnosis of a developing compartment syndrome.

Examination of the extremity often reveals tense and shiny skin that may be significantly bruised. Pain occurs with minimal range of motion of the foot, hand, or any of the extremity with compartment syndrome. The patient may have difficulty moving the extremity without assistance and pain is provoked when the care practitioner takes the affected limb though any range of motion

In chronic compartment syndrome, there may be pain with range of motion of the extremity and muscle bulging may be noticed. Numbness is common but all symptoms usually resolve within a few minutes of discontinuing exercise.

Medically Reviewed by a Doctor on 5/19/2015
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