Compartment Syndrome of the Hand Presenting as Bullous Edema

Abstract

Compartment syndrome of the hand can be a challenging diagnosis to ascertain. The difficulty in diagnosis is in part due to the absence of an established diagnostic criteria. Additionally, when a patient presents obtunded or with an altered sensorium, the identification of compartment syndrome of the hand can be further complicated. Despite the potential difficulty in diagnosis, it is of upmost importance for orthopedic surgeons to recognize and treat this entity in an expeditious manner. Without prompt treatment, the risk is increased morbidity including possible amputation. Here, we present a unique and thought-provoking case along with a review of the literature. The purpose of sharing this case is to highlight potential clues to aid in prompt diagnosis and improve patient outcomes.

Isolated Compartment Syndrome of the Hand After Intravenous Doxycycline Infiltration Injury

“…1 Bullous edema and intrinsic minus positioning may also be early indicators of underlying soft tissue injury preluding compartment syndrome. Braunlich et al 3 described the case of a 60-year-old man with acute bullous eruption of the hand after colonic sigmoidectomy, which progressed to swelling, pain, and intrinsic minus positioning; an underlying intracompartmental hematoma and pressures up to 75 mm Hg were found. Thus, acute development of bullae, in conjunction with the previously mentioned signs, may foreshadow a rise in intracompartmental pressures of the hand.…”