From the Guidelines
Compartment syndrome is characterized by severe pain, pain with passive stretching, tenseness, numbness, weakness, and later stages of pallor and decreased pulses, with early recognition being crucial for prompt fasciotomy to prevent permanent damage. The key signs of compartment syndrome include pain that seems out of proportion to the injury, pain that worsens with passive stretching of the affected muscles, tenseness or hardness of the compartment, numbness or tingling in the area, weakness of the affected muscles, and in later stages, pallor (paleness) and decreased pulses in the extremity 1. The classic "5 P's" often taught are pain, pallor, paresthesia (abnormal sensations), paralysis, and pulselessness, though pain and paresthesia typically appear first.
Clinical Presentation
The clinical presentation of compartment syndrome can be difficult to diagnose, especially in patients receiving sedation or presenting with altered level of consciousness 1. The diagnosis is based on clinical findings, including the "5 P's" and measurement of compartment pressure, with pressures above 30 mmHg generally indicating the need for surgical intervention 1.
Diagnosis and Management
Intracompartmental pressure measurements may be taken if the diagnosis is uncertain, with pressures above 30 mmHg generally indicating the need for surgical intervention 1. The management of compartment syndrome involves early fasciotomy in case of recently formed compartment syndrome, with the goal of preventing permanent muscle and nerve damage 1.
Prognosis and Outcome
Early recognition and prompt treatment of compartment syndrome are crucial to prevent permanent muscle and nerve damage, with delayed treatment leading to increased morbidity, mortality, and limb loss 1. The prognosis and outcome of compartment syndrome depend on the promptness of diagnosis and treatment, with early fasciotomy being the key to preventing long-term damage 1.
From the Research
Signs of Compartment Syndrome
The signs of compartment syndrome can be identified through various clinical findings and symptoms.
- The hallmark symptoms of acute compartment syndrome (ACS) include the 6 P's:
- Pain
- Poikilothermia
- Pallor
- Paresthesia
- Pulselessness
- Paralysis 2
- However, a study published in 2025 suggests that the predictive power of these 6 P's may not be as strong as previously thought, and that other factors such as pressure on palpation may be more informative 3
- Additionally, diagnosis of ACS is often made on the basis of physical examination and repeated intracompartmental pressure (ICP) measures, with an ICP higher than 30 mmHg of diastolic blood pressure being significant of compartment syndrome 4
Clinical Findings
- Clinical findings such as pain, paresthesia, paralysis, pallor, poikilothermia, pulselessness, and pressure on palpation are commonly associated with ACS
- However, the use of single or multiple P's does not guarantee diagnosis, and objective measures such as continuous pressure or a physiologic marker of ischemia may be better indications for compartment syndrome 3
Diagnosis and Treatment
- Diagnosis of ACS is difficult in clinical practice, even among expert surgeons, and currently relies on physical examination and repeated ICP measures 4
- Once diagnosis is made, fasciotomy to release the affected compartment should be performed as early as possible to prevent irreversible ischemic damage to muscles and peripheral nerves 2, 4