Compartment Syndrome Like You Haven’t Seen Before

​The fascial planes in the upper and lower extremities play an important role in function and form, but they also make the extremities vulnerable to compartment syndrome. Emergency physicians are quite comfortable evaluating and diagnosing compartment syndrome: severe unrelenting pain, pain with passive motion of the muscle groups involved, and possibly paresthesias and pallor. The first patient I saw with this condition was at the Tripler Army Medical Center in Hawaii. A sailor dangling his legs over the dock presented after his leg was crushed between the dock and a battleship that suddenly shifted its position. I still remember the patient in the trauma room screaming in severe pain.During my two years as an FBI doctor in the training academy at Quantico, I became quite familiar with chronic and acute exertional compartment syndrome. Agents-in-training and older police officers in physical fitness training would often present with this condition. Severe pain would typically develop in the anterior compartment while they were running and could usually be relieved with rest. Some had this condition chronically, and worked around and through it. Surgical release of the compartment was eventually the outcome for most of these cases.​Compartment syndrome of the hand is another rare condition that can have devastating consequences. Several decades ago, a colleague of mine in Columbus, OH, accidentally impaled her hand with a recently used large central line needle. The w...
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