title: Accuracy of measurement of hand compartment pressures: a cadaveric study.
abstract: OBJECTIVE
  To determine the accuracy of digital palpation for clinical assessment of elevated intracompartmental pressure compared with needle manometry in a simulated compartment syndrome of the hand.
  
  
  METHODS
  Three cadaveric hands were configured with interstitial fluid infusion and an arterial line pressure monitor to create and continuously measure intracompartmental pressure in the thenar and hypothenar compartments. Seventeen assessors clinically judged the presence or absence of compartment syndrome based on digital palpation for firmness and then measured pressures with a handheld manometer. An intracompartmental pressure threshold of 30 mm Hg or greater was used to diagnose compartment syndrome.
  
  
  RESULTS
  The sensitivity and specificity of digital palpation of the thenar eminence were 49% and 79%, respectively, with a positive predictive value (PPV) of 86% and negative predictive value (NPV) of 37%. Using the handheld manometer, the sensitivity and specificity increased to 97% and 86% with a PPV of 95% and NPV of 92%. The sensitivity and specificity of digital palpation of the hypothenar eminence were 62% and 83%, respectively, with improvement of 100% and 100%, respectively, with a handheld manometer. For the hypothenar compartment, use of a handheld manometer improved the PPV from 92% to 100% and the NPV from 40% to 100% compared with digital palpation.
  
  
  CONCLUSIONS
  Digital palpation alone was insufficient to detect elevated compartment pressures in hands at risk for compartment syndrome. Handheld invasive pressure measurement was a useful adjunct for detecting elevated interstitial tissue pressures and may aid in diagnosing compartment syndrome.
  
  
  METHODS
  Diagnostic II.
authors: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA. Electronic address: jcwong330@gmail.com.
authors: Justin C
authors: JC
authors: Wong
authors: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
authors: Michael M
authors: MM
authors: Vosbikian
authors: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
authors: Joseph M
authors: JM
authors: Dwyer
authors: Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA; Department of Orthopaedic Surgery, The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
authors: Asif M
authors: AM
authors: Ilyas
mesh_terms: D002102:Cadaver; D003161:Compartment Syndromes / Q000175:diagnosis* / Q000503:physiopathology; D006225:Hand; D006801:Humans; D008365:Manometry; D010173:Palpation; D012680:Sensitivity and Specificity
keywords: Compartment syndrome; hand trauma; pressure monitor