Juke Stick: A Case of Pediatric Atraumatic Compartment Syndrome

Abstract

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.