Unusual Presentation of Compartment Syndrome

Excerpt

Compartment syndrome can be hidden under various conditions or affect unusual anatomical locations or procedures. Systemic diseases such as diabetes mellitus, hypothyroidism, systemic capillary leak syndrome (Clarkson’s syndrome), HIV, hematological/leukemic disorders, or systemic sclerosis can all be complicated with compartment syndrome. Unusual anatomical locations such as gluteal or paraspinal regions can be affected as well as atypical muscles (medial head of gastrocnemius-tennis leg or peroneus longus). Unusual clinical conditions include exertional compartment syndrome (acute or chronic), spontaneous idiopathic (of unknown origin), neonatal, or following rare infections. Medications which can provoke this syndrome include statins and neuroleptic psychiatric drugs. Moreover, procedures which can very rarely cause compartment syndrome are coronary arterial bypass grafting, neuromonitoring, and total knee replacement. Innocuous distal radius fractures in the elderly have been reported to be complicated by acute compartment syndrome. All these conditions and scenarios should raise awareness to medical personnel for possible compartment syndrome when dealing with patients with unexplained and out of proportion pain along with highly suspicious symptoms. Symptoms and treatment do not differ from the ones in usual compartment syndrome presentation. However, delays in diagnosis have negative implications in regard tothe final outcome.