Differential Diagnosis for Compartment Syndrome

When considering the possibility of compartment syndrome, it's crucial to evaluate other potential diagnoses that could present with similar symptoms. The following differential diagnosis is organized into categories to help guide the thought process:

• Single Most Likely Diagnosis
  • Cellulitis: This is an infection of the skin and subcutaneous tissues. It can cause pain, swelling, and warmth in the affected limb, similar to compartment syndrome. However, cellulitis typically does not cause the same level of pain with passive stretch or the significant decrease in pulse strength that compartment syndrome does.
• Other Likely Diagnoses
  • Deep Vein Thrombosis (DVT): DVT can cause swelling, pain, and warmth in the affected limb, which might be confused with compartment syndrome. However, DVT typically does not cause pain with passive stretch of the muscles.
  • Muscle Strain or Contusion: These injuries can cause significant pain and swelling but usually do not lead to the severe pain with passive stretch or the circulatory compromise seen in compartment syndrome.
• Do Not Miss Diagnoses
  • Neurovascular Injury: Any injury that compromises the nerves or blood vessels can lead to severe and potentially irreversible damage if not promptly addressed. Symptoms can overlap with compartment syndrome, including pain, numbness, and decreased circulation.
  • Infection (e.g., Abscess or Osteomyelitis): While less common, infections can cause severe pain, swelling, and systemic symptoms. Missing an infection could lead to severe consequences, including sepsis.
• Rare Diagnoses
  • Volkmann's Ischemic Contracture: A rare but serious condition resulting from untreated compartment syndrome, leading to muscle and nerve damage.
  • Eosinophilic Fasciitis: A rare condition characterized by inflammation of the fascia, which can mimic compartment syndrome in its presentation of pain and swelling.

Each of these diagnoses requires careful consideration based on the patient's history, physical examination, and diagnostic tests to ensure accurate diagnosis and appropriate treatment. Compartment syndrome is a medical emergency, and any delay in diagnosis can lead to significant morbidity. Therefore, it's essential to rule out compartment syndrome promptly in patients presenting with suggestive symptoms.