From the Guidelines
Compartment syndrome is primarily a clinical diagnosis, and imaging studies are not typically used for initial diagnosis due to the urgency of treatment, with direct compartment pressure measurement being the gold standard diagnostic test, not radiological testing. When it comes to radiology tests, they are not the first line of diagnosis for compartment syndrome, but certain modalities can be helpful in specific situations. Some of the radiology tests that can be used include:
- Ultrasound, which can detect decreased blood flow in affected compartments and identify fluid collections or hematomas that might contribute to increased compartment pressure 1
- MRI, which can show muscle edema and necrosis in later stages, but is rarely used in acute settings due to time constraints
- CT scans, which can help identify fractures or other injuries that could lead to compartment syndrome, but do not directly diagnose the condition itself It's essential to note that compartment syndrome remains a clinical emergency requiring prompt recognition based on symptoms like pain disproportionate to injury, pain on passive stretch, paresthesia, pallor, paralysis, and pulselessness, and that delaying treatment while waiting for imaging results can lead to irreversible muscle and nerve damage, making clinical assessment and direct pressure measurements the mainstay of timely diagnosis, as suggested by the Association of Anaesthetists guideline from 2021 1. In terms of direct measurement of intracompartmental pressure, it can be obtained using a variety of equipment and techniques, including traditional needle manometry, multiparameter monitors, and dedicated transducer-tipped intracompartmental pressure monitors, with the choice of equipment affecting the obtained compartment pressure, as described in the study published in the journal Anaesthesia 1.
From the Research
Radiology Tests for Diagnosing Compartment Syndrome
- There are limited radiology tests specifically used to diagnose compartment syndrome, as diagnosis is often clinical and based on serial examinations 2, 3, 4.
- However, some studies suggest the use of ultrasound to determine the need for fasciotomy in elevated muscle compartment pressure 5.
- Ultrasound indexes have shown excellent correlations with compartment pressures, suggesting potential for clinical use in the future 5.
- Measurement of intracompartmental pressures using a pressure monitor is considered the most reliable test, but noninvasive means of diagnosis are being studied 3.
- Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt 2, 4.
- There is no established radiology test that can reliably diagnose compartment syndrome, and clinical observations such as pain, paralysis, and compartment pressure monitoring are often unreliable determinants of the presence of the syndrome 6.