Diagnosis of compartment syndrome
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Compartment syndrome can be diagnosed early by high index of suspicion. Excessive pain, not relieved with usual doses of analgesics, in a patient with an injury known to cause compartment syndrome must raise an alarm in the mind of the treating doctor. Injuries with a high risk of developing compartment syndrome are as follows: • Supracondylar fracture of the humerus • Forearm bone fractures • Closed tibial fractures • Crush injuries to leg and forearm. Stretch test: This is the earliest sign of impending compartment syndrome. The ischaemic muscles, when stretched, give rise to pain. It is possible to stretch the affected muscles by passively moving the joints in direction opposite to that of the damaged muscle’s action. (e.g., passive extension of fingers produces pain in flexor compartment of the forearm). Other signs include a tense compartment, hypo- aesthesia in the distribution of involved nerves, muscle weakness etc. Compartment syndrome can be confirmed by measuring compartment pressure. A pressure higher than 40 mm of water is indica- tive of compartment syndrome. Pulses may remain palpable till very late in impending compartment syndrome, and should not provide a false sense of security that all is well.