Soft Tissue Case 7 Diagnosis
Compartment syndrome is a clinical diagnosis. The earliest sign will be pain out of proportion to exam, and notably pain with passive flexion of a muscle that runs through the compartment. The compartments in the affected area may be tense, hard, or firm. If the diagnosis is suspected and requires confirmation prior to operative planning, measure the intra-compartment pressure. If the suspicion for ACS is strong enough, fasciotomy in the OR can proceed without checking compartment pressure.
When calculating pressures, the preferred method of diagnosis is the perfusion pressure (or “delta pressure”).
Perfusion pressure (ΔP)=diastolic pressure - intra-compartment pressure
Normal compartment pressure is 10mmHg. Levels >30mmHg are suggestive of compartment syndrome. However when compared to the use of intracompartment pressures >30 mmHg, perfusion pressure < 20 mmHg offered increased specificity and superior likelihood ratios for the diagnosis of ACS and is more commonly used now [3].
How do you measure intra-compartment pressure? Please view this excellent procedures video with Dr. John Sarwark with assistance from Dr. Michael Macias:
For additional information regarding Acute Compartment Syndrome and perfusion pressure, please visit the NUEM Blog:
