History and exam
Key diagnostic factors
common
presence of risk factors
History of trauma, bleeding disorder, compression support, thermal injury, intravenous infusion, venous obstruction, and sports playing should raise suspicion.
Other diagnostic factors
common
pain
Pain out of proportion to the injury or clinical situation is often reported as being the earliest sign of developing acute compartment syndrome.[8] It is especially prominent with passive stretching of the muscles in the involved compartment. Pain that does not improve with adequate analgesia may also indicate a diagnosis of compartment syndrome.[17] The absence of pain can be secondary to altered mental status or a central-peripheral neural deficit but can also be a late finding of compartment syndrome.
pressure (muscle tightness)
Presence of tightness in the compartment is the earliest objective finding. However, manual palpation to detect compartment firmness - a direct manifestation of increased intracompartmental pressure - shows low sensitivity.[22]
paraesthesia
Early sign.[18]
Risk factors
strong
trauma
Extremity fracture, soft-tissue trauma (with or without fracture), reperfusion injury, and/or penetrating trauma can lead to intracompartmental haemorrhage, vascular compromise, and/or muscle oedema with subsequent elevation of intracompartmental interstitial pressure.[18][19] Fractures account for 69% of all cases of acute compartment syndrome.[3] Up to 40% of all cases of acute compartment syndrome involve a tibial shaft fracture, and approximately 4% to 5% of all tibial fractures result in acute compartment syndrome.[4]
bleeding disorder
Bleeding disorders, such as haemophilia, can lead to spontaneous intracompartmental haemorrhage and elevation of intracompartmental pressure.[18]
compression support
thermal injury
With burns, especially in cases of circumferential burn eschar, there is a high risk of intracompartmental interstitial pressure elevation due to the restricting effect of the eschar on the swollen muscles.[18]
intense muscular activity
Chronic exertional compartment syndrome is most frequently encountered among long-distance runners and other sports with intense muscular activity.
weak
extravasation of intravenous infusion
Infused solution that does not get absorbed can lead to elevation of intracompartmental interstitial pressure.[18]
venous obstruction
Iliac venous obstruction secondary to DVT, tumour embolus, or extrinsic compression may lead to elevation of intracompartmental interstitial pressure.[18]
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