Compartment Syndrome of the hand often results from iatrogenic injuries due to IVs or A-lines. Other etiologies include: snake bites, crush injuries to the hand, burns, trauma, and prolonged pressure.
There are ten compartments in the hand:
- Four dorsal interossei
- Three volar interossei
- One hypothenar compartment
- One thenar compartment
- One adductor Pollicis compartment
Compartment syndrome of the hand and fingers will present itself as hypoesthesia on the volar surface of the fingers, tenderness in the palm, and weakness of thumb opposition and limited flexion. Pain will be noted with passive abduction and extension of the thumb. Passive extension of the little finger will cause pain in hypothenar eminence; additionally, the little finger will have limited flexion. The physician will find intrinsic plus hand deformity with flexion of MCP joints and extension of IP joints as well as pain with flexion of the IP joints.
In differentiating between forearm and hand compartment syndrome, the physician will notice that there is pain with passive extension of the fingers with forearm compartment syndrome. With compartment syndrome of the hand, pain will be found with flexion of the IP joints.
A fasciotomy is required if the compartmental pressure is greater than 30mmHg or within 30mmHg of the diastolic hand pressure. When performing a fasciotomy of the hand, there will be two dorsal incisions of the hand in line with the 2nd and 4th metacarpals; however, dorsal incisions alone may not be enough. Additional incisions and/or a carpal tunnel release may be necessary. Furthermore, an incision may be necessary to release the Thenar compartment. An incision is made along the radial aspect of the 1st metacarpal in order to release the thenar compartment. If a release of the hypothenar is necessary, an incision will be made along the ulnar aspect of the 5th metacarpal.
During a finger fasciotomy, a mid-axial incision is given on the ulnar side of the index, middle, and ring fingers and the radial side of the small finger. The surgeon will dissect across the digit, superficial to the flexor tendon sheath. The neurovascular bundles are retracted volarly and dissection is completed across the digit.
