Diagnosis of Compartment Syndrome
Diagnosis of compartment syndrome is based on clinical signs and, when necessary, confirmed through pressure measurements. Due to the urgent nature of this syndrome, especially in acute cases, prompt diagnosis is essential to prevent irreversible tissue damage and preserve limb function.
Clinical Assessment
For acute compartment syndrome, finding the cause relies heavily on recognising key symptoms and patient history. Doctors look for the “6 Ps”:
Pain: Especially when disproportionate to the injury
Pallor: Pale skin suggesting compromised circulation
Paresthesia: Tingling or numbness
Paralysis: Loss of movement
Pulselessness: Absence of distal pulse (rare, late sign)
Pressure: A firm, swollen muscle compartment
In many cases, pain—particularly on passive stretching of the muscles—is the earliest and most consistent sign.
Intracompartmental Pressure Testing | Diagnosis of Compartment Syndrome
If the diagnosis is uncertain, a special needle attached to a pressure monitor can be inserted into the muscle compartment to measure internal pressure. A reading of 30 mmHg or higher is considered diagnostic, especially when accompanied by symptoms.
Imaging
Imaging is not usually required for diagnosis but may be used to rule out other conditions:
MRI or ultrasound: Helpful in identifying chronic exertional compartment syndrome or differentiating from tendonitis or stress fractures.
X-rays: Used to check for fractures in traumatic injuries.
Chronic Compartment Syndrome Diagnosis
For exertional cases, a pressure test may be conducted before and after exercise to observe changes. Elevated post-exercise compartment pressures help confirm the diagnosis.
Timely and accurate diagnosis of compartment syndrome is critical. In acute cases, even short delays in diagnosis and treatment can lead to lasting damage. Clinical vigilance, especially following trauma or surgery, can save limbs and lives.
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