Epidemiology:

• Extremity compartment syndrome occurs when tissue pressure within a limited space of the body compromises circulation, nerve function, and muscle function.
• Compartments enveloped by fascia that prevents tissue expansion can lead to compartment syndrome, due to either internal or external causes of increased tissue pressure.

Compartmental Location and Etiology:

• Common locations of compartment syndromes are in the upper and lower limbs, including the four compartments of the lower extremity and two compartments of the forearm.
• Causes of compartment syndrome include decreased compartmental volume, increased compartmental content, and externally applied pressure.

Pathophysiology of Increased Compartmental Content:

• Increased blood volume in a space limited by noncompliant fascia results in exponential rise in intracompartmental pressure, often caused by traumatic or atraumatic bleeding.
• Postischemic swelling or reperfusion injury can cause the double ischemic insult, leading to increased compartmental volume and pressure.

Clinical Presentation:

• The classic signs of compartment syndrome include pain, pulselessness, pallor, paralysis, and pressure, as well as skin edema, blisters, and swelling.
• Initial signs include swollen or tight compartments with severe pain that is out of proportion to the injury and not relieved by typical analgesia.

Diagnosis and Monitoring:

• Diagnosing compartment syndrome involves evidence of increased intracompartmental pressure and the development of specific signs over time.
• Observation and monitoring of the suspected compartment are necessary to make a definitive diagnosis and initiate definitive treatment.

Diagnosis of Compartment Syndrome:

• To make a diagnosis of compartment syndrome, evidence of increased tissue pressure, inadequate tissue perfusion, and loss of tissue function are required. This could include patient complaints of tightness or pressure in the involved area, evidence of inadequate perfusion, and weakness of the intracompartmental muscles and nerves.
• Clinical signs such as pain out of proportion to the clinical situation, weakness of the muscles in the compartment, pain on a passive stretch of the muscles, hypoesthesia in nerve distribution, and tenseness of the compartmental envelope are associated with the diagnosis. However, clinical symptoms and signs have been found to have poor sensitivity.

Challenges in Clinical Examination:

• Clinical signs progress over time, making clinical decision-making challenging. The clinical examination, while a cornerstone of diagnosis, is subjective and requires patient cooperation, presenting challenges in critically ill patients, pediatric population, and cases where patients are unable to cooperate.