Compartment syndrome vs DVT and cellulitis
How to tell Compartment syndrome and DVT and cellulitis apart when a board question makes them look alike.
Compartment syndrome is ischemic pressure pain with passive stretch; DVT is venous swelling; cellulitis is infectious red warm skin.
Side by side
Compartment syndrome causes severe pain out of proportion, pain with passive stretch, tense compartment, paresthesias, pallor, pulselessness late, and elevated compartment pressure.
DVT causes unilateral swelling and tenderness from venous thrombosis; cellulitis causes erythema, warmth, tenderness, fever, and skin infection.
Raised fascial compartment pressure reduces perfusion and threatens muscle and nerve viability.
DVT is venous clot obstruction; cellulitis is bacterial infection of dermis and subcutaneous tissue.
High compartment pressure and pain with passive stretch support compartment syndrome.
Compression ultrasound supports DVT; skin erythema/warmth with leukocytosis and portal of entry supports cellulitis.
The trap
Swollen painful limb overlaps, but passive-stretch pain and neurovascular compromise make compartment syndrome urgent.
The repair move
For painful swollen limb, first look for ischemic compartment signs before DVT or cellulitis.
Try a free question
CoreA 28-year-old man sustains a closed tibial shaft fracture from a motorcycle crash and undergoes intramedullary nailing. 6 hours postoperatively he develops severe progressive pain in the right calf that is out of proportion to the injury and is not relieved by opioids. Pain is dramatically worsened by passive dorsiflexion of the toes. The compartment feels tense. Which diagnosis is most likely?
Show answer and explanation
Answer: A. Acute compartment syndrome. Acute compartment syndrome is increased pressure within a fascial compartment causing ischemia; classic findings are pain out of proportion to injury, pain on passive stretch of compartment muscles, paresthesias, and a tense compartment; emergent fasciotomy is required; the 5 P's (pain, paresthesia, pallor, paralysis, pulselessness) appear late.
Why the other choices are tempting
- B. DVT presents with calf swelling and pain but without the pain on passive stretch and tense compartment.
- C. Cellulitis has skin erythema, warmth, and fever, not progressive postoperative pain on stretch.
- D. Hematoma is a focal collection without the diffuse compartment tension and pain-on-stretch findings.
- E. Reflex sympathetic dystrophy is a chronic regional pain syndrome, not an acute postoperative event.
Flashcards
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What pain clue supports compartment syndrome?
Pain with passive stretch supports compartment syndrome.
What test supports DVT?
Compression ultrasound supports DVT when the swollen painful limb is venous rather than ischemic from compartment pressure.
Quick answers
What is the fastest way to tell Compartment syndrome from DVT and cellulitis?
Compartment syndrome is ischemic pressure pain with passive stretch; DVT is venous swelling; cellulitis is infectious red warm skin.
What is the key clue for Compartment syndrome?
Compartment syndrome causes severe pain out of proportion, pain with passive stretch, tense compartment, paresthesias, pallor, pulselessness late, and elevated compartment pressure.
What is the key clue for DVT and cellulitis?
DVT causes unilateral swelling and tenderness from venous thrombosis; cellulitis causes erythema, warmth, tenderness, fever, and skin infection.
What is the common trap with Compartment syndrome vs DVT and cellulitis?
Swollen painful limb overlaps, but passive-stretch pain and neurovascular compromise make compartment syndrome urgent.