In what situation would a physical therapist suspect acute compartment syndrome?

• A. Moderate swelling without pain
• B. Pain out of proportion to injury
• C. Stable range of motion with mild discomfort
• D. Absence of sensation in the toes

Answer: (B)

Acute compartment syndrome is a serious condition that occurs when elevated pressure within an enclosed muscle compartment compromises the circulation and function of the tissues within that space. The hallmark sign of this condition is severe pain that is disproportionate to the degree of injury.

In the context of potential compartment syndrome, the presence of pain that feels excessive relative to the observed trauma serves as a key indicator. This discomfort typically intensifies with passive stretching of the affected muscles, indicating that the muscle tissues are under stress due to increased intracompartmental pressure.

While other symptoms, such as swelling and absence of sensation, can be associated with compartment syndrome, they do not specifically indicate the acute condition as clearly as disproportionately severe pain does. For example, moderate swelling without pain might suggest a less severe injury, and stable range of motion accompanied by mild discomfort is generally not an indication of compartment syndrome. Similarly, an absence of sensation in the toes could point to neurological issues or vascular problems but does not definitively signal acute compartment syndrome on its own. Therefore, recognizing the intense pain, particularly if it exceeds what would be expected from the injury, is crucial for suspecting this difficult-to-diagnose condition.