Can compartment syndrome occur in a finger?

Compartment Syndrome in the Finger

Yes, compartment syndrome can definitely occur in a finger, requiring urgent diagnosis and intervention to prevent tissue necrosis and permanent functional impairment. 1, 2

Pathophysiology and Clinical Presentation

Finger compartment syndrome occurs when pressure within the limited digital space increases to a level that compromises blood flow to the finger tissues. The key clinical features include:

• Early signs (most reliable for diagnosis):

  • Pain out of proportion to injury 3
  • Pain on passive extension 4
  • Paresthesia (numbness and tingling) 4, 1
  • Tense edema/swelling 4, 2

• Late signs (indicate advanced compartment syndrome):

  • Pallor of the fingertip 1
  • Decreased capillary refill 2
  • Limited range of motion 1
  • Paralysis 4
  • Pulselessness 5

Common Causes of Finger Compartment Syndrome

Finger compartment syndrome can result from:

• Crush injuries 2
• High-pressure injuries (e.g., high-pressure washer) 1
• Fractures 2
• Pyogenic flexor tenosynovitis 6
• Circumferential burns 7
• Prolonged ischemia 4
• Tight bandages or casts 7

Diagnosis

Compartment syndrome is primarily a clinical diagnosis:

• Assess for the classic signs (pain, paresthesia, tension, limited motion) 5, 4
• In cases where clinical assessment is difficult (obtunded patients, children), compartment pressure measurements may be helpful 5, 4
• A differential pressure (diastolic blood pressure - compartment pressure) <30 mmHg is diagnostic 5

Management

Urgent digital decompression through finger fasciotomy is the definitive treatment for finger compartment syndrome to prevent tissue necrosis and preserve function. 1, 2

The procedure typically involves:

1. Bilateral midline incisions or a unilateral radial approach along the midline of the finger 1, 2
2. Release of the digital fascia to decompress the compartment 2
3. In cases with fractures, appropriate fixation should be performed simultaneously 2

Post-Decompression Care

After fasciotomy:

• Monitor for improved perfusion (capillary refill, color, sensation) 1
• Wound management may include negative pressure wound therapy (NPWT) to facilitate healing 4
• Early physical therapy to maintain range of motion 4
• Consider closure within 7-10 days if possible 4

Prognosis and Complications

• Early diagnosis and treatment generally lead to good outcomes with restoration of normal function 1, 2
• Delayed treatment can result in:
  • Tissue necrosis 1
  • Permanent sensory deficits 7
  • Loss of finger function 7
  • Potential need for amputation in severe cases

Important Clinical Pitfall

A critical pitfall is dismissing finger compartment syndrome as a minor injury. Even seemingly minor mechanisms can produce compartment syndrome in the finger due to its limited space and rigid fascial boundaries 7. Always maintain a high index of suspicion with any finger injury presenting with pain disproportionate to the injury, especially with progressive swelling and sensory changes.