Which of the following is a sign of possible neurovascular compromise in a cast?

• A. Swelling of fingers/toes
• B. Discoloration (cyanosis/pallor)
• C. Decreased pulses
• D. Increased sweating under the cast

Answer: (B)

Discoloration of the distal area signals compromised blood flow and is a critical warning sign when a limb is in a cast. Pallor or a bluish color means the tissues aren’t receiving enough oxygen, which can rapidly lead to tissue injury if not addressed. This direct indication of perfusion status makes color change the most reliable early clue that neurovascular function is in jeopardy, requiring prompt evaluation and possible loosening of the cast or medical intervention.

Swelling can occur under a cast, but by itself it isn’t as specific to perfusion problems. Decreased pulses can occur with significant ischemia, but a pulse may still be present even with serious compromise, so it’s not as sensitive an early indicator. Increased sweating under the cast isn’t a typical sign of vascular compromise.