How to assess for neurovascular compromise above and below a joint?

From the Guidelines

To examine for neurovascular compromise above and below a joint, perform a systematic assessment of circulation, sensation, and motor function in the affected limb, including the use of the ankle-brachial index (ABI) as a diagnostic tool, as recommended by recent studies 1. When assessing circulation, compare the injured limb to the uninjured side, checking for color changes, temperature differences, and capillary refill time. Palpate pulses proximal and distal to the injury site, noting any diminishment or absence.

• Assess sensation by testing light touch in all dermatomes of the affected limb, asking the patient if they can feel your touch and if sensation is normal compared to the uninjured side.
• Evaluate motor function by having the patient perform active movements of the digits and joints distal to the injury, checking for weakness or inability to move.
• Document the "5 P's" of compartment syndrome: pain, pallor, paresthesia, paralysis, and pulselessness, though pulselessness is often a late finding. The ABI is a useful diagnostic tool, with a value of <0.9 having a satisfactory sensitivity and specificity for diagnosing vascular injury, as demonstrated in a study of 93 patients 1.
• To measure the ABI, use a Doppler probe to detect the flow signal in the posterior tibial and dorsalis pedis arteries, and calculate the ratio of the systolic blood pressure at the ankle to the systolic blood pressure at the arm.
• A recent study published in the Journal of the American College of Radiology 1 highlights the importance of non-invasive vascular testing (NIVT) in evaluating patients with symptoms of lower extremity arterial insufficiency. Repeat assessments at regular intervals (typically every 1-2 hours initially) are essential to detect any deterioration in neurovascular status that might require urgent intervention, as emphasized in the guidelines for the acute care of severe limb trauma patients 1.

From the Research

Neurovascular Assessment

To examine for neurovascular compromise above and below a joint, the following steps can be taken:

• Perform a thorough neurovascular assessment, which is an important skill for all registered nurses 2, 3, 4
• The assessment should include careful observation of the patient's limb to detect any signs of compromise, such as changes in color, temperature, or sensation 2
• The nurse should also assess the patient's motor function, including strength and range of motion, to detect any signs of neurovascular compromise 3
• In addition to physical assessment, imaging studies such as MRI or MRA may be used to diagnose neurovascular compression syndromes 5, 6

Imaging Studies

• High-resolution MRI sequences, including T2-weighted images, can be used to detect neurovascular compression syndromes 5
• Magnetic resonance angiography (MRA) can also be used to visualize the blood vessels and detect any signs of compression 5, 6
• Imaging studies should be used in conjunction with physical assessment and patient history to make an accurate diagnosis 6

Importance of Assessment

• Neurovascular assessment is crucial to detect signs of compromise and prevent permanent damage or complications 2, 3
• Delaying the recognition of neurovascular compromise can have serious consequences, including amputation or even death 3
• Accurate assessment and documentation of patient data are essential to communicate with other members of the healthcare team and provide the best possible patient care 4