Compartment syndrome is a medical term which refers to the compression of nerves, blood vessels and muscle inside a closed space (compartment) within the body. This leads to tissue death due to lack of oxygenation as the blood vessels are compressed by the raised pressure within the compartment. Compartment syndrome most commonly involves the forearm and lower leg. It can be divided into acute, subacute or chronic compartment syndrome.
Compartment syndrome Symptoms and signs
There are classically 5 “Ps” associated with compartment syndrome — pain out of proportion to what is expected, paresthesia, pallor, paralysis, pulselessness; sometimes a 6th P, for polar/poikilothermia (failure to thermoregulate) is added. Of these, only the first two are reliable in the diagnosis of compartment syndrome. Paresthesia, however, is a late symptom.
- Pain is often reported early and almost universally. The description is usually of severe, deep, constant, and poorly localized pain, sometimes described as out of proportion with the injury. The pain is aggravated by stretching the muscle group within the compartment and is not relieved by analgesia up to and including morphine.
- Paresthesia (altered sensation e.g. “pins & needles”) in the cutaneous nerves of the affected compartment is another typical sign.
- Paralysis of the limb is usually a late finding. The compartment may also feel very tense and firm (pressure). Some find that their feet and even legs fall asleep. This is because compartment syndrome prevents adequate blood flow to the rest of the leg.
- Note that a lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment.
- Tense and swollen shiny skin, sometimes with obvious bruising of the skin.
- Congestion of the digits with prolonged capillary refill time.
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