Compartment Syndrome

Acute Compartment Syndrome:

Causes: (edema or hemorrhage – swelling within a confined muscle compartment, most common in calf or forearm)

  • Trauma with long bone fracture or without fracture (crush injury, thermal (electrical) burn, vascular injury in extremities)
    • Vascular compromise:
      • Hours after a vascular surgery (embolectomy) – severe calf pain and paresthesia
        • Ischemic-reperfusion syndrome: > 4-6 hours of ischemia causes tissues to suffer both intracellular and insterstitial edema upon reperfusion – increase risk of Compartment Syndrome.
  • Non-traumatic: Prolonged limb compression (cast), animal venom, nephrotic syndrome


  • Early Sx: Pain out of proportion to physical exam/injury (severe pain, exquisitely tender), persistent deep pain, paresthesias
    • Early signs: Swelling of extremity, tightness in the area (skin becomes taunt/tense, extremely tight/firm), muscle weakness, pain worse with passive muscle stretching.
  • Later signs: Absent distal pulses (decrease in arterial blood flow), loss of deep tendon reflexes
  • 5 P’s:”
    • Pain: Severe pain in the affected extremity (ex: calf/forearm)
      • Pain is out of proportion to the PE or injury.
      • Pain is increased/exacerbated by passive stretching of the muscles in the affected compartment.
    • Paresthesia: Burning and tingling sensations, occur in the distribution of the affected peripheral nerve.
    • Pallor (or cyanosis) of the overlying skin: Result of tense swelling and decrease perfusion.
    • Pulselessness: Pulses are initially palpable but become diminished and eventually non-palpable.
    • Paralysis: Resulting from nerve and muscle ischemia and necrosis.

Elevated pressure within a muscular compartment – as tissue swells, the pressure within a given compartment increases due to confinement within the fascia surrounding muscle that does not expand.

  • Complications: As pressure within fascial compartment increases, development of permanent nerve damage and muscle necrosis (from ischemia).

Measure compartment pressures:

  • Compartment pressure > 20-30mmHg – Needs fasciotomy!
    • Tx: Fasciotomy ***Medical emergency! Call orthopedic surgery for stat consult!***
      • Incising the fascial compartment relieves the pressure.

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