Diagnosis

The history, including mechanism of injury, is very important, since many patients at risk for the syndrome are severely ill or injured and cannot relate whether they are experiencing pain. Palpation of the compartments in question may or may not reveal tenseness and swelling; when in doubt, the resuscitating physician should measure tissue pressure.

Alert and intact patients will virtually always relate that they are experiencing severe and constant pain over the involved compartment. Palpation of the compartment will also elicit pain. Active contraction of the involved muscles will increase the pain, as will passive stretching of the muscles ( I§ble..2Z0.-2). Hypoesthesia resulting from compromise of nerves traversing the involved compartment appears at about the same time as muscle weakness and pain.

TABLE 270-2 Symptomatology of Acute Compartment Syndromes

Possible compartment syndromes associated with injuries such as fractures or penetrating wounds should prompt an immediate surgical consultation, since the presence of a compartment syndrome may influence subsequent treatment choices.

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