Compartment Syndromes of the Upper Extremity

John Gray Seiler III, MD, Patrick J. Casey, MD, Atlanta, Ga; Sandra Haas Binford, MAEd, Winston- Salem, NC

J South Orthop Assoc. 2000;9(4) 

In This Article

Introduction

The diagnosis and treatment of compartment syndrome is one of the most challenging problems in orthopaedic surgery. The myriad causes of compartment syndrome and the severe soft tissue findings that are associated with limb trauma make assessment of this condition difficult and the outcome from treatment variable. While the general findings that characterize compartment syndrome are agreed upon, the absolute diagnostic criteria remain controversial.

Compartment syndrome is a condition that occurs when interstitial tissue pressures (ITPs) rise within an enclosed fascial envelope, preventing adequate tissue oxygenation and ultimately causing cellular necrosis of the compartment contents. This clinical condition may be classified as either acute or chronic. Acute compartment syndrome occurs when an injury or condition, such as blunt or penetrating trauma, infection, burns, or vascular injury, causes prolonged elevation of ITP. Chronic or exertional compartment syndrome occurs when there is an increase in muscle activity and a temporary rise in pressures. When the activity is stopped, the pressures dissipate and the symptoms resolve.

Compartment syndrome most commonly involves the leg and forearm, though it can also affect the hand, foot, shoulder, thigh, and buttock. In the awake and alert patient, the diagnosis is based on clinical signs and symptoms. Characteristically, there is pain out of proportion to the injury, pain with passive movement of the compartment musculature, tense compartments to palpation, paresthesias, and eventually paralysis. In contrast, compartment syndrome in a patient with altered mental status, neurologic injury, or polytrauma can easily be overlooked. Simply considering it as a possibility may be the most important factor leading to its diagnosis.

Since the diagnosis is difficult and the results of delayed treatment are often poor, it is not surprising that compartment syndrome is one of the most common causes of litigation against doctors in North America.[1] The economic cost of a missed case of compartment syndrome is difficult to estimate. Gulli and Templeman[2] found that the average malpractice award from missed compartment syndrome was approximately $280,000.

While there is consensus regarding the general findings that characterize compartment syndrome, specific objective criteria remain a source of controversy. We provide an overview of acute upper extremity compartment syndrome. The causes, pathophysiology, diagnosis, and treatment of this condition are reviewed.

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