Suspected acute compartment syndrome
Recommended: Clinical + compartment pressures (imaging adjunctive only) is generally not preferred as the imaging study for suspected acute compartment syndrome. Surgical emergency — fasciotomy.
Recommended study
Clinical + compartment pressures (imaging adjunctive only)
Surgical emergency — fasciotomy. Do not delay for imaging. MRI / US do not substitute for clinical exam.
If the default doesn't apply
Compartment pressures + clinical exam are sufficient
Stryker needle measurement (delta pressure < 30 mmHg → fasciotomy)
No contrast
Vascular injury concern
CT
CTA Extremity (only if delay would not compromise limb)
IV contrast
Watch-outs
Six Ps + tense compartment
Even one cardinal sign in the right context warrants compartment pressure measurement and surgical consult.
Pain out of proportion to injury
Most sensitive early sign — precedes paresthesia and pulselessness.
Pearls
- Most common locations: lower leg (anterior compartment), forearm.
- Delta pressure (diastolic BP − compartment pressure) < 30 mmHg → fasciotomy.
- Crush injury, fractures, reperfusion injury, tight casts, anticoagulation are common precipitants.