Suspected Hand Compartment Syndrome
Tight, swollen hand after injury
All Pathways
Plastic SurgeryEmergency
Hand Compartment Syndrome
Hand Compartment Syndrome: Suspected Hand Compartment Syndrome → Common Etiologies → Hand Compartments (10 total) → Clinical Diagnosis (6 Ps) → Compartm...
Pathway Overview
10 steps
Algorithm Steps
10 total
01Start 02Action Common Etiologies
What causes hand compartment syndrome?
- TRAUMA:
- - Crush injury
- - Fractures (metacarpal, carpal)
- - High-pressure injection
- - Burns (circumferential)
- VASCULAR:
- - Arterial injury/ligation
- - Reperfusion after ischemia
- OTHER:
- - Snake bite (venom edema)
- - IV infiltration
- - Tight cast/dressing
- - Bleeding (coagulopathy)
03Action Hand Compartments (10 total)
Anatomic spaces
- THENAR (1): Thumb intrinsics
- HYPOTHENAR (1): Small finger intrinsics
- ADDUCTOR POLLICIS (1): Deep to thenar
- INTEROSSEI (4): Between metacarpals
- - 3 palmar + 1 dorsal per web space
- - Often counted as 4 or 7
- CARPAL TUNNEL (1): Median nerve, flexors
- GUYON'S CANAL (1): Ulnar nerve/artery
- FINGER COMPARTMENTS: Each digit
04Warning Clinical Diagnosis (6 Ps)
PAIN is most reliable early sign
- PAIN: Out of proportion to injury
- - Pain with PASSIVE STRETCH (key finding)
- - Stretch intrinsics (extend MPs + flex PIPs)
- PRESSURE: Tense compartments
- PARALYSIS: Late sign - motor weakness
- PARESTHESIAS: Nerve compression
- PALLOR: Late, indicates ischemia
- PULSELESSNESS: Very late (unreliable)
- NOTE: Pulses often present with CS
05Action Compartment Pressure Measurement
Objective confirmation
- INDICATIONS:
- - Unconscious/unreliable patient
- - Equivocal exam
- - Regional/spinal anesthesia
- TECHNIQUE:
- - Stryker needle or arterial line setup
- - Measure ALL compartments
- - Interossei: Dorsal approach
- THRESHOLDS:
- - Absolute: >30 mmHg concerning
- - Delta P: DBP - compartment <30 mmHg
- - Either indicates release
06Decision Compartment Syndrome Confirmed?
Clinical diagnosis OR pressure confirmation
07Action Urgent Hand Fasciotomy
Surgical decompression
- TIMING: Within 6 hours optimal
- INCISIONS:
- - Thenar: Radial border of thumb metacarpal
- - Hypothenar: Ulnar border of hand
- - Interossei: 2 DORSAL incisions
- - 2nd/4th metacarpal intervals
- - Release all 4 interossei
- - Carpal tunnel: Palmar incision
- TECHNIQUE:
- - Incise skin AND fascia
- - Visualize muscle (should bulge)
- - Leave wounds OPEN
- - Delayed closure at 3-5 days
08Action Postoperative Care
After fasciotomy
- WOUND CARE:
- - Moist dressings
- - VAC therapy option
- - Return to OR in 48-72h
- DELAYED CLOSURE:
- - Primary if <5 days
- - Skin graft if needed
- THERAPY:
- - Early passive motion
- - Edema control
- - Splinting in intrinsic plus
09Outcome Outcomes
Prognosis
- Early release (<6h): Good outcomes
- Delayed release: Permanent damage
- COMPLICATIONS of missed CS:
- - Intrinsic contracture (claw hand)
- - Volkmann's ischemic contracture
- - Permanent nerve damage
- - Loss of function
- LEGAL: High medicolegal risk
10Action Close Monitoring
If not immediately surgical
- ONLY if diagnosis uncertain AND:
- - Pressures normal
- - No pain with passive stretch
- - Good perfusion
- MONITORING:
- - Serial exams q2h
- - Elevate hand (not above heart)
- - Remove all constricting items
- - Keep patient warm
- - Low threshold for surgery
- Path rejoins step 07Shared downstream outcome
Guideline Source
Hand Compartment Syndrome Management Consensus
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Clinical diagnosis can be difficult
- Multiple compartments must be assessed
- Unconscious patients harder to diagnose
- Delayed treatment causes permanent damage
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Hand Compartment Syndrome?
The Hand Compartment Syndrome is a emergency clinical algorithm for Plastic Surgery. It provides a structured decision tree to guide clinical decision-making, based on Hand Compartment Syndrome Management Consensus.
What guideline is the Hand Compartment Syndrome based on?
This algorithm is based on Hand Compartment Syndrome Management Consensus (DOI: N/A).
What are the limitations of the Hand Compartment Syndrome?
Known limitations include: Clinical diagnosis can be difficult; Multiple compartments must be assessed; Unconscious patients harder to diagnose; Delayed treatment causes permanent damage. Individual patient factors may require deviation from these recommendations.
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