Non-Invasive Diagnostics in Acute Compartment Syndrome

Diagnosis of acute compartment syndrome (ACS) of the extremities is based on clinical signs with or without complementary measurement of muscle compartmental pressure. However, in cases of imminent compartment syndrome, unconscious patients or children the appropriate diagnose remains challenging. Despite all efforts to improve technical devices to objectify the signs by measurements of numerous parameters, needle compartment pressure measurement is to date accepted as the gold standard to facilitate decision making. But its invasiveness, the controversy about pressure thresholds and its potentially limited validity due to a single measurement support the need for further developments to diagnose ACS. Numerous technical improvements have been published and revealed promising new applications for non-invasive diagnostics. Since the pathology of an ACS is well characterized two approaches of measurements are described: to detect either increasing compartmental pressure or decreasing perfusion pressure. In the following, currently known investigations are reviewed and related to their pathophysiological principals, modes of clinical application, value and reliability.