How do you measure girth for compartment syndrome?

How to Measure Girth for Compartment Syndrome

Girth measurement is NOT a standard or recommended diagnostic tool for compartment syndrome—diagnosis relies on clinical signs (pain out of proportion, pain on passive stretch) and direct compartment pressure measurement when diagnosis is uncertain. 1, 2

Why Girth Measurement is Not Used

The evidence-based approach to compartment syndrome diagnosis does not include girth measurement as a diagnostic criterion. Here's why:

• Clinical diagnosis is primary: Compartment syndrome is diagnosed clinically based on pain out of proportion to injury and pain with passive muscle stretch 2
• Direct pressure measurement is the only adjunctive tool: When clinical diagnosis remains uncertain (particularly in obtunded, confused, or uncooperative patients), direct measurement of intracompartmental pressure using needle manometry, multiparameter monitors, or dedicated transducer-tipped monitors is recommended 1, 2
• Palpation alone is unreliable: Even palpating compartment tension has poor diagnostic accuracy (sensitivity 54%, specificity 76% in children), making serial girth measurements even less useful 1, 2

The Correct Diagnostic Approach

Clinical Signs to Monitor (Every 30-60 Minutes in First 24 Hours)

• Pain out of proportion to injury is the earliest and most reliable warning sign 2, 3
• Pain on passive stretch of the affected muscle compartment is the most sensitive early sign 1, 2
• Increasing firmness/tension of the compartment on palpation (though unreliable in isolation) 2
• Paresthesia (sensory changes) from nerve ischemia 2
• Paresis (motor deficits) is a late sign indicating significant tissue damage 1, 2
• Pulselessness, pallor, and decreased temperature are late signs indicating irreversible damage has likely occurred 1, 2

When to Measure Compartment Pressure

• Obtunded, sedated, or uncooperative patients who cannot report pain 1, 2
• When clinical diagnosis remains uncertain despite serial examination 1, 2
• Diagnostic thresholds: Fasciotomy indicated when compartment pressure ≥30 mmHg OR differential pressure (diastolic BP minus compartment pressure) ≤30 mmHg 1, 2

Critical Pitfalls to Avoid

• Never wait for late signs (pulselessness, pallor, paralysis)—these indicate irreversible tissue damage has already occurred 1, 2
• Never rely on any single measurement technique like girth or palpation alone for diagnosis 1, 2
• Never delay surgical consultation to obtain measurements—when compartment syndrome is suspected, remove constricting dressings immediately, position limb at heart level, and arrange urgent surgical consultation 2
• Never elevate the limb excessively—this further decreases perfusion pressure and worsens compartment syndrome 2, 4

Use of Scoring Charts

• The Royal College of Nursing scoring charts are recommended to maintain heightened awareness among healthcare workers caring for at-risk patients, though clinical signs alone are not completely reliable 1
• Recording clinical signs serially helps track progression rather than relying on any single measurement 1