What are the five P's of compartment syndrome?

• A. Paresthesia, Pain, Pressure, Pallor, Pulselessness
• B. Pain, Pallor, Paresthesia, Pulselessness, Pressure
• C. Pain, Paresthesia, Pressure, Pallor, Pulselessness
• D. Pallor, Pain, Pressure, Paresthesia, Pulselessness

Answer: (A)

Rising pressure within a closed muscle compartment compromises blood flow and nerve function, so recognizing the pattern of signs is crucial for quick intervention. The five P’s describe this progression: Pain that is out of proportion to exam and worsened by passive stretch; Paresthesias from nerve ischemia; Pressure as the elevated intracomartmental pressure itself; Pallor from reduced perfusion; and Pulselessness, which is a late sign of severe ischemia. These clues together alert you to urgent decompression to prevent muscle necrosis and nerve damage. While the order can vary and some signs (like paralysis) are discussed in other mnemonics, the combination of Pain, Paresthesias, Pressure, Pallor, and Pulselessness best captures the typical presentation.