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The ability to diagnose a compartment syndrome is a critical skill for the Emergency Physician (EP). Early identification of a compartment syndrome can enable the appropriate treatment and may facilitate limb salvage. A compartment syndrome begins when an imbalance of volume and pressure within a myofascial compartment results in diminished blood flow.1 A compartment syndrome has been classically described in the early literature as a Volkmann ischemic contracture following vascular insufficiency in the forearm.3

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A compartment syndrome can occur in almost any muscle group that is contained within a confined fascial space. Common locations include the leg, forearm, and gluteal area. There are many causes of a compartment syndrome. These include protracted muscle ischemia secondary to necrosis from a contusion, swelling secondary to volume overload states or a fracture, or a thrombus in a vessel that traverses the compartment. In the Emergency Department (ED), a compartment syndrome is most commonly associated with long bone fractures or blunt trauma.2 Most compartment syndromes are caused by trauma; 58% of all cases are due to fractures of the tibia or forearm.27 Other etiologies for a compartment syndrome include complications from a coagulopathy, dialysis, surgery, or states of obtundation (Table 74-1).46

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Table 74-1 Common Causes of a Compartment Syndrome
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Identifying a compartment syndrome in a timely fashion can be challenging. The sensitivity and specificity of manual palpation to identify a compartment syndrome is 24% and 55%, respectively.34 Manual palpation has a positive predictive value of 19% and a negative predictive value of 63%.34 Thus, manual palpation cannot be used to rule in or rule out a compartment syndrome. The hallmark symptom is persistent and progressive pain that is disproportionate to the underlying cause. The pain typically increases with passive motion. A catastrophic mistake is to attribute the etiology of the patient's pain solely to the underlying problem, such as the fracture or trauma.7,8 Other signs and symptoms associated with a compartment syndrome occur late in the course and include paresthesias of the involved nerve, paralysis of the involved muscle group, pallor of the skin, and diminished pulses.9 Waiting for the development of all the clinical signs and symptoms is an invitation for permanent and dangerous sequelae, including muscle necrosis and possible loss of a limb. Measurement of elevated tissue pressure within the muscle compartment is currently the most common objective ...

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