In compartment syndrome, which sign is last to appear?

In compartment syndrome, which sign is last to appear?

• A. Pulselessness
• B. Pain
• C. Swelling
• D. Paralysis

Answer: (A)

In compartment syndrome, tissue pressure rises and the signs appear in a progression as perfusion worsens. The earliest clue is pain out of proportion to exam, often intensified by passive stretching of the involved muscles. Swelling may be present but isn’t a reliable early indicator. As ischemia advances, nerves become affected: patients notice numbness or tingling, followed by weakness and, if pressure isn’t relieved, paralysis. Vascular signs like a missing or weakened pulse come far later; arterial flow can be preserved even when deep tissues are acutely ischemic, so the absence of a pulse is a late, unreliable sign. Thus, pulselessness is the last sign to appear. If compartment syndrome is suspected, urgent measurement and decompression are required to prevent irreversible muscle and nerve damage.

In compartment syndrome, tissue pressure rises and the signs appear in a progression as perfusion worsens. The earliest clue is pain out of proportion to exam, often intensified by passive stretching of the involved muscles. Swelling may be present but isn’t a reliable early indicator. As ischemia advances, nerves become affected: patients notice numbness or tingling, followed by weakness and, if pressure isn’t relieved, paralysis. Vascular signs like a missing or weakened pulse come far later; arterial flow can be preserved even when deep tissues are acutely ischemic, so the absence of a pulse is a late, unreliable sign. Thus, pulselessness is the last sign to appear. If compartment syndrome is suspected, urgent measurement and decompression are required to prevent irreversible muscle and nerve damage.