Compartment syndrome of the hand and wrist

High clinical suspicion is of paramount importance in evaluating the hand or wrist for an evolving compartment syndrome. A detailed history coupled with a thorough physical examination form the basis for the diagnosis. The use of techniques to measure compartment pressures forms the objective foundation to assist in formulating the correct treatment plan. The particular technique used to measure the compartments is not critical as long as the information is evaluated in the context of the history and physical examination. No absolute threshold pressure exists over which a fasciotomy is indicated. The need for immediate fasciotomy once the diagnosis is made is clear, however. No one can be faulted for proceeding with a fasciotomy on clinical grounds alone, even when the appearance of findings typically associated with compartment syndrome at surgery (herniating muscle bellies, edema, etc.) are less than convincing. At their worst, the wounds from a fasciotomy present a cosmetic challenge. Great fault can be assigned, however, to the clinician who chooses to ignore an evolving compartment syndrome that unnecessarily places the patient at risk of permanent disability. Here, the cosmetic benefit of avoiding the fasciotomy is overwhelmed by the often-devastating dysfunction created by ischemic damage to the contents of the affected compartments. Once the damage is done, it is permanent. A thorough understanding of the pertinent anatomy is critical to safe, efficacious treatment. Handled promptly and judiciously, compartment syndrome of the hand and wrist can be managed effectively, decreasing the morbidity associated with this potentially devastating and debilitating process.