Compartment syndrome happens when pressure builds inside a closed muscle compartment and cuts off blood flow to the muscles and nerves. A tight cast after a fracture can cause or hide it, and muscle can die within hours.
Key symptoms
- Pain out of proportion to the injury that keeps getting worse
- Pain with passive stretching of the fingers or toes
- Feeling of tightness or pressure under the cast
- Tingling or numbness
- Weakness of the fingers or toes, a late sign
What you find on exam
- Neurovascular check: color, warmth, capillary refill, sensation and movement
- Pain on passive stretch of the muscles in the compartment
- Firm, tense compartment above or below the cast
- Pulses, which often stay present until late
- Compare with the other limb
Tests
- Diagnosis is mainly clinical; do not delay treatment for tests
- Compartment pressure measurement if the exam is unclear
- Creatine kinase and urine myoglobin for muscle damage
- Kidney function and potassium
Treatment basics
- Raise the limb only to heart level, not higher
- Split the cast and padding down to the skin right away
- Call the surgeon urgently
- Emergency fasciotomy if pressure stays high or signs persist
- IV fluids if muscle breakdown affects the kidneys
Red flags
- Pain not relieved by usual pain medicine
- Pain on passive stretch with a tense compartment
- Numbness, weakness or a pale, cold limb
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Related guides
Sources: Open RN, Nursing Skills 2e (Chippewa Valley Technical College); NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.