Compartment Syndrome - Symptoms and Signs

Symptoms and Signs

There are classically 6 "Ps" associated with compartment syndrome — pain out of proportion to what is expected based on the physical exam findings, paresthesia, pallor, paralysis, pulselessness, and pressure. The first signs of compartment syndrome are numbness, tingling and paresthesia. Loss of function, and decreased pulses or pulselessness however,are late signs. Some symptoms of compartment syndrome are paresthesia, palpable pulse, paresis and pallor. According to Shears paresthesia in the distribution of the nerves transversing the affected compartment has also been described as relatively early sign of compartment syndrome, and later is followed by anesthesia (Shears, 2006). The other three symptoms of compartment syndrome are palpable pulse, paresis and pallor. These symptoms are irreversible and consistent during compartment syndrome and its part of the diagnosis (Shears, 2006).

• Pain is often reported early and almost universally. The description is usually of exquisite, deep, constant, and poorly localized pain out of proportion with the findings on physical examination (often incorrectly described as pain out of proportion to the injury). The pain is aggravated by passively stretching the muscle group within the compartment or actively flexing it (though this finding is not specific to compartment syndrome alone) and is not relieved by analgesia up to and including morphine.
• Paresthesia (altered sensation e.g. "pins & needles") in the cutaneous nerves of the affected compartment is another typical sign.
• Paralysis of the limb is usually a late finding. The compartment may also feel very tense and firm (pressure). Some find that their feet and even legs fall asleep. This is because compartment syndrome prevents adequate blood flow to the rest of the leg.
• Note that a lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often well below arterial pressures and pulse is only affected if the relevant artery is contained within the affected compartment.
• Tense and swollen shiny skin, sometimes with obvious bruising of the skin.
• Congestion of the digits with prolonged capillary refill time.