Muscle groups are covered with a tough, inelastic tissue called fascia. This envelope of tissue creates a compartment that contains muscles, nerves, veins, and arteries. After injury or surgery, swelling of muscles causes increased pressure in fascial compartment because fascia cannot expand. Pressure closes off capillaries, arterioles, and eventually arteries, and this results in ischemia that will progress to necrosis if not treated. Compartment syndrome is more common in extremities, particularly anterior or posterior compartments of the lower leg, but it is possible at other sites of injury (e.g., abdomen).

Clinical Findings

• Severe pain not relieved by opioid analgesics and unusual for injury. Pain worsens with stretching of involved muscles. This pain is first symptom to appear. Once other signs are evident, process is well established, and tissue damage is probable.
• Pallor—paleness of involved extremity.
• Pulselessness—loss of pulses or markedly diminished pulses of affected extremity.
• Paresthesia—numbness and tingling.
• Paralysis—loss of ability to move extremity.
• Diminished capillary refill time (>3 sec).

Possible Causes: Severe muscle injury, burns, fractures.

Collaborative Management

• Extreme pain is first warning sign. When pain is more severe than expected, immediately consider compartment syndrome, and notify HCP.
• Although pain medication should not be delayed or withheld, do not simply medicate and return later to see if medication is working; stay with Pt, and perform a focused assessment.
• Elevate extremity to level of heart to prevent further swelling and increase venous return.
• Palpate pulses. Use Doppler if not palpable. Do not put ice bags on extremity.
• Note skin color, and determine if pallor is present.
• Blanch skin, and check capillary refill time.
• Assess nerves in affected extremity for altered sensation or impaired mobility.
• Continue to monitor vascular status. Pain indicates ischemia, but if pallor or pulselessness develops, tissue necrosis and permanent damage will occur.
• Remain with Pt until provider arrives. Loss of pulses and extreme pain that accompanies compartment syndrome constitute a surgical emergency.
• Assist with pressure measurements of affected compartment.
• Get Pt ready for an emergency fasciotomy in OR: draw blood, obtain IV access, determine time of Pt’s last meal or fluids.