Research Article| Volume 50, ISSUE 3, P627-632, March 2019

Use of standard musculoskeletal ultrasound to determine the need for fasciotomy in an elevated muscle compartment pressure cadaver leg model

Published:January 14, 2019DOI:


      • Readily available ultrasound technology can be used to detect elevated muscle compartment pressures.
      • Pressure used to generate deformity (flattening) of the fascial planes, in comparison to the uninvolved extremity, may be the best index to use.
      • The manuscript demonstrates proof of concept on the anterior leg compartment that needs to be validated on other compartments and clinically.


      Introduction: Acute compartment syndrome (ACS) is a limb-threatening condition often associated with leg injury. The only treatment of ACS is fasciotomy with the purpose of reducing muscle compartment pressures (MCP). Patient discomfort and low reliability of invasive MCP measurements, has led to the search for alternative methods. Our goal was to test the feasibility of using ultrasound to diagnose elevated MCP.
      Methods: A cadaver model of elevated MCPs was used in 6 cadaver legs. An ultrasound transducer was combined with a pressure sensing transducer to obtain a B-mode image of the anterior compartment, while controlling the amount of pressure applied to the skin. MCP was increased from 0 to 75 mmHg. The width of the anterior compartment (CW) and the pressure needed to flatten the bulging superficial compartment fascia (CFFP) were measured.
      Results: Both the CW and CFFP showed high correlations to MCP in the individual cadavers. Average CW and CFFP significantly increased between baseline and the first elevated MCP states. Both Inter-observer and intra-observer agreements for the ultrasound measurements were good to excellent.
      Discussion: Ultrasound indexes showed excellent correlations in compartment pressures, suggesting that there is a potential for the clinical use of this modality in the future.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Harvey E.J.
        • Sanders D.W.
        • Shuler M.S.
        • et al.
        What’s new in acute compartment syndrome?.
        J Orthop Trauma. 2012; 26: 699-702
        • Stahel P.F.
        • Mauser N.
        • Gissel H.
        • et al.
        Acute lower-leg compartment syndrome.
        Orthopedics. 2013; 36: 619-624
        • Olson S.A.
        • Glasgow R.R.
        Acute compartment syndrome in lower extremity musculoskeletal trauma.
        JAAOS - J Am Acad Orthopaed Surg. 2005; 13: 436
        • Schmidt A.H.
        Acute compartment syndrome.
        Injury. 2017; 48: S22-S25
        • Masquelet A.C.
        Acute compartment syndrome of the leg: pressure measurement and fasciotomy.
        Orthop Traumatol Surg Res. 2010; 96: 913-917
        • Prayson M.J.
        • Chen J.L.
        • Hampers D.
        • et al.
        Baseline compartment pressure measurements in isolated lower extremity fractures without clinical compartment syndrome.
        J Trauma Inj Infect Crit Care. 2006; 60: 1037-1040
        • McQueen M.M.
        • Duckworth A.D.
        • Aitken S.A.
        • et al.
        The estimated sensitivity and specificity of compartment pressure monitoring for acute compartment syndrome.
        J Bone Jt Surg. 2013; 95: 673-677
        • Whitney A.
        • O’Toole R.V.
        • Hui E.
        • et al.
        Do one-time intracompartmental pressure measurements have a high false-positive rate in diagnosing compartment syndrome?.
        J Trauma Acute Care Surg. 2014; 76: 479-483
        • O’Toole R.V.
        • Whitney A.
        • Merchant N.
        • et al.
        Variation in diagnosis of compartment syndrome by surgeons treating tibial shaft fractures.
        J Trauma. 2009; 67: 735-741
        • McQueen M.M.
        • Duckworth A.D.
        The diagnosis of acute compartment syndrome: a review.
        Eur J Trauma Emerg Surg. 2014; 40: 521-528
        • Arbabi S.
        • Brundage S.I.
        • Gentilello L.M.
        Near-infrared spectroscopy: a potential method for continuous, transcutaneous monitoring for compartmental syndrome in critically injured patients.
        J Trauma Inj Infect Crit Care. 1999; 47: 829-833
        • Garr J.L.
        • Gentilello L.M.
        • Cole P.A.
        • et al.
        Monitoring for compartmental syndrome using near-infrared spectroscopy: a noninvasive, continuous, transcutaneous monitoring technique.
        J Trauma Inj Infect Crit Care. 1999; 46 (discussion 617–8): 613-616
        • Gentilello L.M.
        • Sanzone A.
        • Wang L.
        • Liu P.Y.
        • Robinson L.
        Near-infrared spectroscopy versus compartment pressure for the diagnosis of lower extremity compartmental syndrome using electromyography-determined measurements of neuromuscular function.
        J Trauma. 2001; 51 (discussion 8-9): 1-8
        • Bariteau J.T.
        • Beutel B.G.
        • Kamal R.
        • et al.
        The use of near-infrared spectrometry for the diagnosis of lower-extremity compartment syndrome.
        Orthopedics. 2011; 34: 178
        • Lee S.H.
        • Padilla M.
        • Lynch J.E.
        • et al.
        Noninvasive measurements of pressure for detecting compartment syndromes.
        J Orthop Rheumatol. 2013; 1: 5
        • Lynch J.E.
        • Lynch J.K.
        • Cole S.L.
        • et al.
        Noninvasive monitoring of elevated intramuscular pressure in a model compartment syndrome via quantitative fascial motion.
        J Orthop Res. 2009; 27: 489-494
        • Garabekyan T.
        • Murphey G.C.
        • Macias B.R.
        • et al.
        New noninvasive ultrasound technique for monitoring perfusion pressure in a porcine model of acute compartment syndrome.
        J Orthop Trauma. 2009; 23 (discussion 193–4): 186-193
        • Wiemann J.M.
        • Ueno T.
        • Leek B.T.
        • et al.
        Noninvasive measurements of intramuscular pressure using pulsed phase-locked loop ultrasound for detecting compartment syndromes: a preliminary report.
        J Orthop Trauma. 2006; 20: 458-463
        • Lynch J.E.
        • Heyman J.S.
        • Hargens A.R.
        Ultrasonic device for the noninvasive diagnosis of compartment syndrome.
        Physiol Meas. 2004; 25 (N1–9)
        • Jones W.G.
        • Perry M.O.
        • Bush H.L.
        Changes in tibial venous blood flow in the evolving compartment syndrome.
        Arch Surg. 1989; 124: 801-804
        • Brandenburg J.E.
        • Eby S.F.
        • Song P.
        • et al.
        Ultrasound elastography: the new frontier in direct measurement of muscle stiffness.
        Arch Phys Med Rehabil. 2014; 95: 2207-2219
        • Carlsen J.F.
        • Ewertsen C.
        • Lönn L.
        • et al.
        Strain elastography ultrasound: an overview with emphasis on breast cancer diagnosis.
        Diagnostics (Basel). 2013; 3: 117-125
        • Nightingale K.R.
        • Palmeri M.L.
        • Nightingale R.W.
        • et al.
        On the feasibility of remote palpation using acoustic radiation force.
        J Acoust Soc Am. 2001; 110: 625-634
        • Bamber J.
        • Cosgrove D.
        • Dietrich C.F.
        • et al.
        EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: basic principles and technology.
        © Georg Thieme Verlag KG, 2013: 169-184
        • Eby S.F.
        • Song P.
        • Chen S.
        • et al.
        Validation of shear wave elastography in skeletal muscle.
        J Biomech. 2013; 46: 2381-2387
        • Morrow D.A.
        • Haut Donahue T.L.
        • Odegard G.M.
        • et al.
        Transversely isotropic tensile material properties of skeletal muscle tissue.
        J Mech Behav Biomed Mater. 2010; 3: 124-129
        • Shuler F.D.
        • Dietz M.J.
        Physicians’ ability to manually detect isolated elevations in leg intracompartmental pressure.
        J Bone Jt Surg. 2010; 92: 361-367
        • Aaron R.
        • Huang M.
        • Shiffman C.A.
        Anisotropy of human muscle via non-invasive impedance measurements.
        Phys Med Biol. 1997; 42: 1245-1262
        • Nelson B.P.
        • Chason K.
        Use of ultrasound by emergency medical services: a review.
        Int J Emerg Med. 2008; 1: 253-259
        • Wang S.-H.
        • Lin K.-Y.
        • Yang J.-J.
        • et al.
        The thickness of the anterior compartment does not indicate compartment syndrome in acutely traumatised legs?.
        Injury. 2014; 45: 578-582
        • Sellei R.M.
        • Hingmann S.J.
        • Weber C.
        • et al.
        Assessment of elevated compartment pressures by pressure-related ultrasound: a cadaveric model.
        Eur J Trauma Emerg Surg. 2015; 41: 639-645
        • Sellei R.M.
        • Hingmann S.J.
        • Kobbe P.
        • et al.
        Compartment elasticity measured by pressure-related ultrasound to determine patients “at risk” for compartment syndrome: an experimental in vitro study.
        Patient Saf Surg. 2015; 9: 4
        • Uthoff H.
        • Thalhammer C.
        • Potocki M.
        • et al.
        Central venous pressure at emergency room presentation predicts cardiac rehospitalization in patients with decompensated heart failure.
        Eur J Heart Fail. 2010; 12: 469-476