I. Definition
A. Condition in which increased tissue pressure within a limited space compromises the circulation and function of the contents within that space
B. A compartment consists of bone, blood vessels, nerves, muscles, and soft tissue lying within a fascial envelope. Fascia is a nonexpanding tissue that contributes to the syndrome.
C. Of the body’s 46 compartments, 38 are in the arms and legs.
D. Can also occur in the abdominal muscle compartments in trauma and/or surgical patients
II. Etiology/incidence/predisposing factors
A. Space-limiting envelope
1. Circumferential dressings
2. Casts
3. Splints
4. Eschar and/or scars
B. Increased intracompartmental contents owing to
1. Bleeding/hemorrhage
2. Coagulation disorders
3. Iatrogenic: infiltrated intravenous sites, improper positioning
4. Venous pooling/obstruction
5. Increased capillary filtration
a. Trauma/surgery
b. Crush syndrome
c. Tissue ischemia/reperfusion injuries
e. Snake/spider bites
f. Intermittent swelling and fluid shifts in extremity compartments during exercise that return to baseline after cessation of the exercise event
g. Supranormal trauma resuscitation
III. Subjective findings
A. Pain out of proportion to injury
B. History of trauma event
C. Complaints of paresthesias, decreased sensation in affected limb
D. Feelings of “heaviness” in affected extremity
IV. Physical examination findings
The six Ps
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A. Pain on passive stretch of affected compartment
B. Paresthesias along dermatomal patterns
C. Paralysis of affected limb
D. Pulses
1. Early: bounding distal pulses as compensatory mechanism
2. Late: pulselessness
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