Compartment Pressure Measurement

  • Evaluation of patients with suspected compartment syndrome based on:
    • Tight muscle compartment in patients with extremity trauma or bleeding, pain out of proportion to exam, paresthesias, or otherwise unexplained limb ischemia
  • Limb may be salvageable for up to 10-12 hours, but with very high pressures, the time period may be as little as 4 hours.
  • Infection overlying site of needle insertion
  • Use sterile technique and local anesthesia.
  • The compartment to be measured should be at the same level as the heart.
  • Needle placement is perpendicular to the skin:
    • Lower Leg (see Figure 19.11)
      • Anterior compartment: Needle entry point is 1 cm lateral to the anterior border of the tibia.
      • Deep posterior compartment: Needle entry point is just posterior to the medial border of the tibia.
      • Lateral compartment: Needle entry point is just anterior to the posterior border of the fibula
      • Superficial posterior compartment: Needle entry point is 3-5 cm on either side of a vertical line drawn down the middle of the calf at the junction between the proximal and middle thirds of the lower leg.
    • Forearm (see Figure 19.12)
    • Volar compartment: Needle entry point is just medial to the palmaris longus.
    • Dorsal compartment: Needle entry point is 1-2 cm lateral to the posterior aspect of the ulna.
    • Pressures can be measured either with an arterial line pressure measurement system or with a Stryker Intracompartmental pressure monitor system.
  • Infection, pain, inaccurate readings, exacerbation of compartment syndrome by injection of fluid into compartment
  • Falsely elevated pressures may be a result of needles placed into tendons or fascia, plugged catheters, or faulty electronic systems. Falsely low readings may result from bubbles in the lines or transducer, plugged catheters, or faulty electronic systems.
  • Proper needle placement can be confirmed by seeing a rise in pressure during digital compression of the compartment just proximal or distal to the needle insertion site, or by contraction of muscle in compartment being measured.
  • Compartment pressure of 30 mm Hg is considered by some to be diagnostic of compartment syndrome. However, this is an imperfect test with both false positives and false negatives. Interventions should be informed by history, exam, and compartment pressure measurements.
  • Fasciotomy is the standard treatment for compartment syndrome. However, compartment syndrome may be treated with hyperbaric O2 therapy. Additionally, compartment syndrome resulting from snake bites should not be treated with fasciotomy.