Emergency Medicine Residency, Carl R. Darnall Army Medical Center, Fort Cavazos, TX 76544, USA.
Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.
Mil Med. 2024 Feb 27;189(3-4):e897-e901. doi: 10.1093/milmed/usad355.
Compartment syndrome is usually due to trauma but can also have atraumatic causes. It is defined as a compromise of neurovascular and muscle function that presents symptomatically with the six P's: pain, pallor, paresthesia, paralysis, poikilothermia, and pulselessness. Diagnosis is confirmed by a delta pressure of <30 mmHg (diastolic blood pressure minus the compartment pressure). This case details a 15-year-old male football player with atraumatic compartment syndrome in the lateral compartment of the right lower leg. Symptoms of swelling and pain began 2 weeks before presentation after the patient was "juked." The patient's symptoms improved after a week of rest but worsened when he returned to practice. In the emergency department, the patient was able to ambulate with pain and declined pain medication. Examination revealed severe tenderness, mildly decreased strength, decreased sensation, and edema in the lateral compartment via bedside ultrasound. Because of the concern for compartment syndrome, pressure was checked with a disposable manometer (Compass CT disposable pressure transducer) revealing a delta pressure of 26 mmHg. The patient consequently underwent fasciotomy, eventually returning to baseline function without deficits. Awareness of this atypical presentation of compartment syndrome will assist providers in making a critical diagnosis and preventing severe complications and disability. This case also demonstrates the potential of disposable pressure transducers for cost-effective and accurate diagnostic confirmation of compartment syndrome in the emergency department.
筋膜室综合征通常由创伤引起，但也可由非创伤性原因引起。它被定义为神经血管和肌肉功能的受损，其临床表现为“六 P”症状：疼痛、苍白、感觉异常、麻痹、皮温降低和无脉。通过测量压力差（舒张压减去筋膜室内压）<30mmHg 可确诊。本病例详细介绍了 1 例 15 岁男性足球运动员，其右侧小腿外侧筋膜室发生非创伤性筋膜室综合征。肿胀和疼痛症状在就诊前 2 周出现，当时患者被“踢了一下”。患者休息一周后症状有所改善，但恢复训练后症状恶化。在急诊科，患者可在疼痛情况下行走，并拒绝使用止痛药。床边超声检查显示外侧筋膜室有严重压痛、轻度肌力下降、感觉减退和水肿。由于担心发生筋膜室综合征，使用一次性压力计（Compass CT 一次性压力传感器）进行了压力检查，结果显示压力差为 26mmHg。因此，患者接受了筋膜切开术，最终恢复到基线功能，无任何功能障碍。了解这种不典型的筋膜室综合征表现将有助于临床医生做出关键诊断，预防严重并发症和残疾。本病例还展示了在急诊科使用一次性压力传感器进行成本效益高且准确的筋膜室综合征诊断的潜力。
