Compartment syndrome

Compartment syndrome usually presents within a few hours of an inciting event, but it may present anytime up to 48 hours after. The earliest symptom is a tense, "wood-like" feeling in the affected limb. There may also be decreased pulses, paralysis, and pallor, along with paresthesia.{{Cite journal | vauthors = McGrath H, Geddes JA, Brown D, Ghosh S |date=2023-12-01 |title=Paediatric well leg compartment syndrome following femoral fracture fixation: A case report |journal=Journal of Orthopaedic Reports |volume=2 |issue=4 |pages=100203 |doi=10.1016/j.jorep.2023.100203 |issn=2773-157X|doi-access=free }} Usually, NSAIDs cannot relieve the pain.{{cite journal | vauthors = Via AG, Oliva F, Spoliti M, Maffulli N | title = Acute compartment syndrome | journal = Muscles, Ligaments and Tendons Journal | volume = 5 | issue = 1 | pages = 18–22 | date = 2015-03-27 | pmid = 25878982 | pmc = 4396671 }} High compartment pressure may limit the range of motion{{cite journal | vauthors = Frink M, Hildebrand F, Krettek C, Brand J, Hankemeier S | title = Compartment syndrome of the lower leg and foot | journal = Clinical Orthopaedics and Related Research | volume = 468 | issue = 4 | pages = 940–950 | date = April 2010 | pmid = 19472025 | pmc = 2835588 | doi = 10.1007/s11999-009-0891-x }} In acute compartment syndrome, the pain will not be relieved with rest. In chronic exertional compartment syndrome the pain will dissipate with rest.{{cite journal | title = Exertional Compartment Syndrome | journal = StatPearls | year = 2020 | pmid = 31335004 | url = http://www.ncbi.nlm.nih.gov/books/NBK544284/ | access-date = 2020-01-22 | publisher = StatPearls Publishing | vauthors = Chandwani D, Varacallo MA }}

File:Acute Compartment Syndrome with blister formation.JPG

There are five signs and symptoms of acute compartment syndrome. They are known as the "5 Ps": pain, pallor, decreased pulse, paresthesia, and paralysis. Pain and paresthesia are the early symptoms of compartment syndrome.{{cite journal | vauthors = Via AG, Oliva F, Spoliti M, Maffulli N | title = Acute compartment syndrome | journal = Muscles, Ligaments and Tendons Journal | volume = 5 | issue = 1 | pages = 18–22 | year = 2015 | pmid = 25878982 | pmc = 4396671 }}

Common symptoms are:

• Pain: A person may feel pain greater than the exam findings. This pain may not be relieved by strong painkillers, including opioids like morphine.{{cite journal | vauthors = Tran AA, Lee D, Fassihi SC, Smith E, Lee R, Siram G | title = A systematic review of the effect of regional anesthesia on diagnosis and management of acute compartment syndrome in long bone fractures | journal = European Journal of Trauma and Emergency Surgery | volume = 46 | issue = 6 | pages = 1281–1290 | date = December 2020 | pmid = 32072224 | doi = 10.1007/s00068-020-01320-5 }} It may be due to nerve damage from ischemia. A person may experience pain disproportionate to the findings of the physical examination.{{cite journal | vauthors = Lorange JP, Laverdière C, Corban J, Montreuil J, Harvey EJ | title = Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis | journal = Journal of Orthopaedic Trauma | volume = 37 | issue = 8 | pages = e319–e325 | date = August 2023 | pmid = 37053115 | doi = 10.1097/BOT.0000000000002610 }} The pain is aggravated by passively stretching the muscle group within the compartment. However, such pain may disappear in the late stages of the compartment syndrome.
• Paresthesia (altered sensation): A person may complain of "pins and needles," numbness, and a tingling sensation. This may progress to loss of sensation (anesthesia) if no intervention is made.

Uncommon symptoms are:

• Paralysis: Paralysis of the limb is a rare, late finding. It may indicate both a nerve or muscular lesion.
• Pallor: Pallor describes the loss of color to the affected limb. Other skin changes can include swelling, stiffness, or cold temperature.
• Pulselessness: A lack of pulse rarely occurs in patients, as pressures that cause compartment syndrome are often lower than arterial pressures. Absent pulses occur only with arterial injury or late-stage compartment syndrome, when pressures are very high.

Chronic exertional compartment syndrome, CECS, may cause pain, tightness, cramps, weakness, and numbness.{{cite journal | vauthors = Dunn JC, Waterman BR | title = Chronic exertional compartment syndrome of the leg in the military | journal = Clinics in Sports Medicine | volume = 33 | issue = 4 | pages = 693–705 | date = October 2014 | pmid = 25280617 | doi = 10.1016/j.csm.2014.06.010 }} This pain can last for months or even years, but rest may relieve it. There may also be mild weakness in the affected area.

Exercise causes these symptoms. They start with muscle tightness, then a painful burning if exercise continues. After exercise stops, the compartment pressure will drop in a few minutes. This will relieve the pain. Symptoms will occur after a certain level of exercise. This threshold can range anywhere from 30 seconds of running to 2–3 miles of running.{{cite journal | vauthors = Schubert AG | title = Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release | journal = International Journal of Sports Physical Therapy | volume = 6 | issue = 2 | pages = 126–141 | date = June 2011 | pmid = 21713230 | pmc = 3109896 }} CECS most often occurs in the lower leg. The anterior compartment is most affected. Foot drop is a common symptom.{{cite journal | vauthors = Bong MR, Polatsch DB, Jazrawi LM, Rokito AS | title = Chronic exertional compartment syndrome: diagnosis and management | journal = Bulletin | volume = 62 | issue = 3–4 | pages = 77–84 | year = 2005 | pmid = 16022217 | url = http://hjdbulletin.org/files/archive/pdfs/639.pdf }}{{cite journal| vauthors = Awbrey B, Shingo T |title=Chronic Exercise-Induced Compartment Syndrome of the Leg|journal=Harvard Orthopaedic Journal|volume=1|issue=7|url=http://www.orthojournalhms.org/volume1/html/articles07.html|access-date=16 October 2014|url-status=live|archive-url = https://web.archive.org/web/20150924061850/http://www.orthojournalhms.org/volume1/html/articles07.html|archive-date=24 September 2015 }}

Acute compartment syndrome (ACS) is a medical emergency. It can develop after traumatic injuries, like car accidents, gunshot wounds, fractures, or intense sports.{{cite journal | vauthors = Mortensen SJ, Orman S, Serino J, Mohamadi A, Nazarian A, von Keudell A | title = Factors Associated with Development of Traumatic Acute Compartment Syndrome: A Systematic Review and Meta-analysis | journal = The Archives of Bone and Joint Surgery | volume = 9 | issue = 3 | pages = 263–271 | date = May 2021 | pmid = 34239953 | pmc = 8221439 | doi = 10.22038/abjs.2020.46684.2284 }} Examples include a severe crush injury or an open or closed fracture of an extremity. Rarely, ACS can develop after a minor injury or another medical issue.{{cite journal | vauthors = Taylor RM, Sullivan MP, Mehta S | title = Acute compartment syndrome: obtaining diagnosis, providing treatment, and minimizing medicolegal risk | journal = Current Reviews in Musculoskeletal Medicine | volume = 5 | issue = 3 | pages = 206–213 | date = September 2012 | pmid = 22644598 | pmc = 3535085 | doi = 10.1007/s12178-012-9126-y }} It can also affect the thigh, buttock, hand, abdomen, and foot. The most common cause of acute compartment syndrome is a fractured bone, usually the tibia.{{cite journal | vauthors = Bodansky D, Doorgakant A, Alsousou J, Iqbal HJ, Fischer B, Scicluna G, Bowers M, Narayan B | title = Acute Compartment Syndrome: Do guidelines for diagnosis and management make a difference? | journal = Injury | volume = 49 | issue = 9 | pages = 1699–1702 | date = September 2018 | pmid = 29699733 | doi = 10.1016/j.injury.2018.04.020 | s2cid = 13853546 }} Leg compartment syndrome occurs in 1% to 10% of tibial fractures. It is strongly linked to tibial diaphysis fractures and other tibial injuries.{{cite journal | vauthors = Stella M, Santolini E, Sanguineti F, Felli L, Vicenti G, Bizzoca D, Santolini F | title = Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review | journal = Injury | volume = 50 Suppl 2 | issue = Suppl 2 | pages = S57–S64 | date = July 2019 | pmid = 30772051 | doi = 10.1016/j.injury.2019.01.047 | s2cid = 73504127 }} Direct injury to blood vessels can reduce blood flow to soft tissues, causing compartment syndrome. Compartment syndrome can also be caused by:

• intravenous drug injection
• casts
• prolonged limb compression
• crush injuries
• anabolic steroid use
• vigorous exercise
• eschar from burns{{cite journal | vauthors = Konstantakos EK, Dalstrom DJ, Nelles ME, Laughlin RT, Prayson MJ | title = Diagnosis and management of extremity compartment syndromes: an orthopaedic perspective | journal = The American Surgeon | volume = 73 | issue = 12 | pages = 1199–1209 | date = December 2007 | pmid = 18186372 | doi = 10.1177/000313480707301201 | s2cid = 1175827 | doi-access = free }}{{cite journal | vauthors = Salcido R, Lepre SJ | title = Compartment syndrome: wound care considerations | journal = Advances in Skin & Wound Care | volume = 20 | issue = 10 | pages = 559–65; quiz 566–7 | date = October 2007 | pmid = 17906430 | doi = 10.1097/01.ASW.0000294758.82178.45 | s2cid = 39527465 }}

Patients on anticoagulant therapy, or those with blood disorders such as hemophilia or leukemia are at higher risk of developing compartment syndrome.{{cite journal | vauthors = Nagase Y, Ueda S, Matsunaga H, Yoshioka A, Okada Y, Machida T, Nakata K, Mima F, Takeda R, Hayashi D, Iio S, Okita K, Narahara H, Yasunaga Y, Inui Y, Kawata S | title = Acute compartment syndrome as the initial manifestation of chronic-phase chronic myeloid leukemia: a case report and review of the literature | journal = Journal of Medical Case Reports | volume = 10 | issue = 1 | pages = 201 | date = July 2016 | pmid = 27443161 | pmc = 4957314 | doi = 10.1186/s13256-016-0985-5 | doi-access = free }}{{cite journal | vauthors = Donaldson J, Goddard N | title = Compartment syndrome in patients with haemophilia | journal = Journal of Orthopaedics | volume = 12 | issue = 4 | pages = 237–241 | date = December 2015 | pmid = 26566325 | pmc = 4601993 | doi = 10.1016/j.jor.2015.05.007 }}

Abdominal compartment syndrome occurs when the intra-abdominal pressure exceeds 20 mmHg and abdominal perfusion pressure is less than 60 mmHg. There are many causes, which can be broadly grouped into three mechanisms: primary (internal bleeding and swelling); secondary (vigorous fluid replacement as an unintended complication of resuscitative medical treatment, leading to the acute formation of ascites and a rise in intra-abdominal pressure); and recurrent (compartment syndrome that has returned after the initial treatment of secondary compartment syndrome).{{cite journal | vauthors = Maerz L, Kaplan LJ | title = Abdominal compartment syndrome | journal = Critical Care Medicine | volume = 36 | issue = 4 Suppl | pages = S212–S215 | date = April 2008 | pmid = 18382196 | doi = 10.1097/CCM.0b013e318168e333 | s2cid = 23747298 }}{{cite journal | vauthors = Khot Z, Murphy PB, Sela N, Parry NG, Vogt K, Ball IM | title = Incidence of Intra-Abdominal Hypertension and Abdominal Compartment Syndrome: A Systematic Review | journal = Journal of Intensive Care Medicine | volume = 36 | issue = 2 | pages = 197–202 | date = February 2021 | pmid = 31808368 | doi = 10.1177/0885066619892225 }}

Compartment syndrome after snake bite is rare.{{cite journal | vauthors = Dhar D | title = Compartment Syndrome Following Snake Bite | journal = Oman Medical Journal | volume = 30 | issue = 2 | pages = e082 | date = March 2015 | pmid = 30834067 | pmc = 6387663 | doi = 10.5001/omj.2015.32 }} Its incidence varies from 0.2 to 1.36% as recorded in case reports.{{cite journal | vauthors = Hsu CP, Chuang JF, Hsu YP, Wang SY, Fu CY, Yuan KC, Chen CH, Kang SC, Liao CH | title = Predictors of the development of post-snakebite compartment syndrome | journal = Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | volume = 23 | issue = | pages = 97 | date = November 2015 | pmid = 26561300 | pmc = 4642665 | doi = 10.1186/s13049-015-0179-y | doi-access = free }} Compartment syndrome after a snake bite is more common in children. Increased white blood cell count of more than 1,650/μL and aspartate transaminase (AST) level of more than 33.5 U/L are associated with developing compartment syndrome. Otherwise, those bitten by venomous snakes should be observed for 48 hours to exclude the possibility of compartment syndrome.

Acute compartment syndrome due to severe/uncontrolled hypothyroidism is rare.{{cite journal | vauthors = Modi A, Amin H, Salzman M, Morgan F | title = Acute compartment syndrome caused by uncontrolled hypothyroidism | journal = The American Journal of Emergency Medicine | volume = 35 | issue = 6 | pages = 937.e5–937.e6 | date = June 2017 | pmid = 28043728 | doi = 10.1016/j.ajem.2016.12.054 | s2cid = 43908781 }}

When repeated use of the muscles causes compartment syndrome, it is chronic compartment syndrome (CCS).{{cite journal | vauthors = Wanich T, Hodgkins C, Columbier JA, Muraski E, Kennedy JG | title = Cycling injuries of the lower extremity | journal = The Journal of the American Academy of Orthopaedic Surgeons | volume = 15 | issue = 12 | pages = 748–756 | date = December 2007 | pmid = 18063715 | doi = 10.5435/00124635-200712000-00008 }}{{cite journal | vauthors = Verleisdonk EJ | title = The exertional compartment syndrome: A review of the literature | journal = Ortopedia, Traumatologia, Rehabilitacja | volume = 4 | issue = 5 | pages = 626–631 | date = October 2002 | pmid = 17992173 }} This is usually not an emergency, but loss of circulation can damage nearby nerves and muscles. The damage may be temporary or permanent.

A subset of chronic compartment syndrome is chronic exertional compartment syndrome (CECS), often called exercise-induced compartment syndrome (EICS).{{cite journal | vauthors = Cetinus E, Uzel M, Bilgiç E, Karaoguz A, Herdem M | title = Exercise induced compartment syndrome in a professional footballer | journal = British Journal of Sports Medicine | volume = 38 | issue = 2 | pages = 227–229 | date = April 2004 | pmid = 15039267 | pmc = 1724759 | doi = 10.1136/bjsm.2003.004630 }} CECS is often a diagnosis of exclusion.{{cite journal | vauthors = Liu B, Barrazueta G, Ruchelsman DE | title = Chronic Exertional Compartment Syndrome in Athletes | journal = The Journal of Hand Surgery | volume = 42 | issue = 11 | pages = 917–923 | date = November 2017 | pmid = 29101975 | doi = 10.1016/j.jhsa.2017.09.009 }} CECS of the leg is caused by exercise.{{cite journal | vauthors = Touliopolous S, Hershman EB | title = Lower leg pain. Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg | journal = Sports Medicine | volume = 27 | issue = 3 | pages = 193–204 | date = March 1999 | pmid = 10222542 | doi = 10.2165/00007256-199927030-00005 | s2cid = 28536488 }} This condition occurs commonly in the lower leg and various other locations within the body, such as the foot or forearm. CECS can be seen in athletes who train rigorously in activities that involve constant repetitive actions or motions.

ACS is defined as a critical pressure increase within a confined compartmental space causing a decline in the perfusion pressure to the tissue within that compartment . A normal human body needs a pressure gradient for blood flow.{{cite journal | vauthors = Stella M, Santolini E, Sanguineti F, Felli L, Vicenti G, Bizzoca D, Santolini F | title = Aetiology of trauma-related acute compartment syndrome of the leg: A systematic review | journal = Injury | volume = 50 Suppl 2 | pages = S57–S64 | date = July 2019 | pmid = 30772051 | doi = 10.1016/j.injury.2019.01.047 }} It must go from the higher-pressure arterial system to the lower-pressure venous system. This causes blood to back up. Excess fluid leaks from the capillaries into the spaces between the soft tissue's cells.{{Citation | vauthors = Lent-Schochet D, Jialal I |title=Physiology, Edema |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK537065/ |access-date=2025-01-23 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30725750 }} This swells the extracellular space and raises the pressure in the compartment.{{cite journal | vauthors = Donaldson J, Haddad B, Khan WS | title = The pathophysiology, diagnosis and current management of acute compartment syndrome | journal = The Open Orthopaedics Journal | volume = 8 | issue = 1 | pages = 185–193 | date = 2014-06-27 | pmid = 25067973 | pmc = 4110398 | doi = 10.2174/1874325001408010185 }} The swelling of the soft tissues around the blood vessels compresses the blood and lymphatic vessels. This causes more fluid to enter the extracellular spaces, leading to further compression. The pressure keeps rising due to the non-compliant fascia in the compartment. This cycle can cause tissue ischemia, a lack of oxygen, and necrosis, or tissue death. Paresthesia, or tingling, can start as early as 30 minutes after tissue ischemia begins.{{cite journal | vauthors = Semenza GL | title = Series introduction: tissue ischemia: pathophysiology and therapeutics | journal = The Journal of Clinical Investigation | volume = 106 | issue = 5 | pages = 613–614 | date = September 2000 | pmid = 10974010 | pmc = 381293 | doi = 10.1172/JCI10913 }} Permanent damage can occur 12 hours after the injury starts.

File:Compartment Syndrome in Muscle (cleaned up) (annotated).jpg

The reduced blood supply can trigger inflammation. This can cause the soft tissues to swell. Reperfusion therapy can worsen this inflammation. The fascia that defines the limbs' compartments does not stretch. Even a small bleed or muscle swelling can greatly raise the pressure.

The pathophysiology of CECS is not entirely understood. In CECS, pressure in an anatomical compartment increases due to a 20% increase in muscle volume. This builds pressure in the tissues and muscles, causing ischemia. Increased muscle weight reduces the compartment volume of the surrounding fascial borders, raising compartment pressure. An increase in the pressure of the tissue can force fluid to leak into the interstitial space (extracellular fluid), leading to a disruption of the micro-circulation of the leg.

File:Compartment syndrome - updated.jpg

Compartment syndrome is a clinical diagnosis. It comes from a provider's exam and the patient's history. Diagnosis may also require measuring intracompartmental pressure. Using both methods increases the accuracy of diagnosing compartment syndrome. A transducer connected to a catheter is inserted 5 cm into the zone of injury to measure the intracompartmental pressure. Normal pressure is 10 mmHg. Anything greater can compromise circulation, and 30 mmHg has been commonly cited as the upper threshold before circulation is lost.

Noninvasive methods, like near-infrared spectroscopy (NIRS), show promise in controlled settings.{{cite journal | vauthors = Walters TJ, Kottke MA, Hargens AR, Ryan KL | title = Non-invasive Diagnostics for Extremity Compartment Syndrome following Traumatic Injury: A State of the Art Review | journal = The Journal of Trauma and Acute Care Surgery | volume = 87 | pages = S59–S66 | date = 2019-04-01 | issue = 1S Suppl 1 | pmid = 31246908 | doi = 10.1097/TA.0000000000002284 | s2cid = 195765995 }} NIRS uses sensors on the skin. However, with limited data, the gold standard for diagnosis is the clinical presentation and intracompartmental pressure.

Chronic exertional compartment syndrome is often diagnosed by ruling out other conditions. The key sign is that there are no symptoms when at rest.{{cite journal | vauthors = Davis DE, Raikin S, Garras DN, Vitanzo P, Labrador H, Espandar R | title = Characteristics of patients with chronic exertional compartment syndrome | journal = Foot & Ankle International | volume = 34 | issue = 10 | pages = 1349–1354 | date = October 2013 | pmid = 23669162 | doi = 10.1177/1071100713490919 | s2cid = 25833426 }} The best test is to measure intracompartmental pressures after running, when symptoms return. Tests like X-rays, CT scans, and MRIs help rule out other problems. But they don't confirm compartment syndrome/ However, MRI is effective for diagnosing chronic exertional compartment syndrome.{{Citation | vauthors = Kang O, Gerstenmaier J |title=Chronic exertional compartment syndrome |date=2013-03-17 |work=Radiopaedia.org |url=http://radiopaedia.org/articles/22182 |access-date=2025-01-23 |language=en |doi=10.53347/rid-22182 |doi-access=free }}

File:Fasciotomy (Post Skin-Graft).jpg

If external compression, such as a cast or tourniquet, has caused increased pressure, it is removed and the limb placed at heart level. Otherwise, fasciotomy, a cut into the fascia beneath the skin, immediately decreases pressure and is generally the only effective treatment. Although closing a fasciotomy wound quickly reduces complications, this is not typically achievable as compartment syndrome may recur. Before the wound is closed, it may be covered with moist dressings or, in some cases, treated with negative-pressure wound therapy, which can additionally be used for closure. Closure is often achieved using the so-called shoelace technique, where staples are inserted into the skin which are used to pull the sides of the wound together with a thread. A skin graft may be needed to close the wound.{{Citation | vauthors = Igoumenou VG, Kokkalis ZT, Mavrogenis AF |title=Fasciotomy Wound Management |date=2019 |work=Compartment Syndrome |pages=83–95 | veditors = Mauffrey C, Hak DJ, Martin III MP |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-22331-1_9 |pmid=32091732 |isbn=978-3-030-22330-4 }} Fasciotomy is often not necessary when compartment syndrome is caused by snake bites, where pressure may instead be relieved with antivenom.{{cite journal | vauthors = Türkmen A, Temel M | title = Algorithmic approach to the prevention of unnecessary fasciotomy in extremity snake bite | journal = Injury | volume = 47 | issue = 12 | pages = 2822–2827 | date = December 2016 | pmid = 27810154 | doi = 10.1016/j.injury.2016.10.023 }}

Chronic exertional compartment syndrome can be treated by reducing or stopping exercise and other activities; massage; non-steroidal anti-inflammatory medication; and physiotherapy If symptoms persist after basic treatment, compartment syndrome may be treated with a fasciotomy.{{cite web |author=Undersea and Hyperbaric Medical Society |title=Crush Injury, Compartment syndrome, and other Acute Traumatic Ischemias |url=http://www.uhms.org/ResourceLibrary/Indications/CrushInjury/tabid/274/Default.aspx |url-status=dead |archive-url=https://web.archive.org/web/20080508193828/http://www.uhms.org/ResourceLibrary/Indications/CrushInjury/tabid/274/Default.aspx |archive-date=2008-05-08}}

Researchers have reported a mortality rate of 47% for acute compartment syndrome of the thigh.{{cite journal | vauthors = Ojike NI, Roberts CS, Giannoudis PV | title = Compartment syndrome of the thigh: a systematic review | language = English | journal = Injury | volume = 41 | issue = 2 | pages = 133–136 | date = February 2010 | pmid = 19555950 | doi = 10.1016/j.injury.2009.03.016 }} A study showed the fasciotomy rate for acute compartment syndrome ranges from 2% to 24%. The key factor in acute compartment syndrome is the time to diagnosis and fasciotomy. A missed or late diagnosis may require limb amputation to survive.{{cite journal | vauthors = Glass GE, Staruch RM, Simmons J, Lawton G, Nanchahal J, Jain A, Hettiaratchy SP | title = Managing missed lower extremity compartment syndrome in the physiologically stable patient: A systematic review and lessons from a Level I trauma center | journal = The Journal of Trauma and Acute Care Surgery | volume = 81 | issue = 2 | pages = 380–387 | date = August 2016 | pmid = 27192464 | doi = 10.1097/TA.0000000000001107 | s2cid = 28382682 }}{{cite journal | vauthors = Long B, Koyfman A, Gottlieb M | title = Evaluation and Management of Acute Compartment Syndrome in the Emergency Department | journal = The Journal of Emergency Medicine | volume = 56 | issue = 4 | pages = 386–397 | date = April 2019 | pmid = 30685220 | doi = 10.1016/j.jemermed.2018.12.021 | s2cid = 59306552 }} After a fasciotomy, some symptoms may be permanent. It depends on which compartment was affected, the time until surgery, and muscle necrosis. Muscle necrosis can happen fast, sometimes within just 3 hours after an injury. A fasciotomy in the leg's lateral compartment might cause symptoms affecting nearby nerves and muscles. These may include foot drop, numbness along leg, numbness of big toe, pain, and loss of foot eversion.

If pressure is not relieved, tissues may die (necrosis) in the affected compartment. Blood will be unable to enter the smallest vessels. Capillary perfusion pressure will fall. This, in turn, leads to a gradual lack of oxygen in the tissues that depend on this blood supply.{{Cite journal |vauthors=Shears E, Porter K |date=October 2006 |title=Acute compartment syndrome of the limb |journal=Trauma |volume=8 |issue=4 |pages=261–266 |doi=10.1177/1460408606076963 |s2cid=70421198}} Without enough oxygen, the tissue will die. On a large scale, this can cause Volkmann's contracture in the affected limbs.{{Cite book |title=Green's operative hand surgery. Volume 2 |date=2017 |publisher=Elsevier |isbn=978-1-4557-7427-2 |edition=Seventh |location=Philadelphia, PA}}{{cite journal | vauthors = Hargens AR, Romine JS, Sipe JC, Evans KL, Mubarak SJ, Akeson WH | title = Peripheral nerve-conduction block by high muscle-compartment pressure | language = en-US | journal = The Journal of Bone and Joint Surgery. American Volume | volume = 61 | issue = 2 | pages = 192–200 | date = March 1979 | pmid = 217879 | doi = 10.2106/00004623-197961020-00006 }}{{cite journal | vauthors = Cone J, Inaba K | title = Lower extremity compartment syndrome | journal = Trauma Surgery & Acute Care Open | volume = 2 | issue = 1 | pages = e000094 | date = 2017-10-01 | pmid = 29766095 | pmc = 5877908 | doi = 10.1136/tsaco-2017-000094 }} It is permanent and irreversible. Other complications include neurological deficits, gangrene, and chronic regional pain syndrome.{{cite journal | vauthors = Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV | title = Compartment syndrome of the forearm: a systematic review | journal = The Journal of Hand Surgery | volume = 36 | issue = 3 | pages = 535–543 | date = March 2011 | pmid = 21371630 | doi = 10.1016/j.jhsa.2010.12.007 }} Rhabdomyolysis and kidney failure are also possible.{{cite journal | vauthors = McKinney B, Gaunder C, Schumer R | title = Acute Exertional Compartment Syndrome with Rhabdomyolysis: Case Report and Review of Literature | journal = The American Journal of Case Reports | volume = 19 | pages = 145–149 | date = February 2018 | pmid = 29415981 | pmc = 5813520 | doi = 10.12659/AJCR.907304 }} Some case series report rhabdomyolysis in 23% of patients with ACS.

In a case series of 164 people with acute compartment syndrome, 69% had an associated fracture.{{cite journal | vauthors = McQueen MM, Gaston P, Court-Brown CM | title = Acute compartment syndrome. Who is at risk? | journal = The Journal of Bone and Joint Surgery. British Volume | volume = 82 | issue = 2 | pages = 200–203 | date = March 2000 | pmid = 10755426 | doi = 10.1302/0301-620x.82b2.0820200 | doi-access = }} The article's authors found that the yearly rate of acute compartment syndrome is 1 to 7.3 cases per 100,000 people. It varies greatly by age and gender in trauma. Men are ten times more likely than women to get ACS. The mean age for ACS is 30 in men and 44 in women. People under 35 may get ACS more often. This is likely because they have more muscle mass. The anterior compartment of the leg is where ACS usually happens.{{cite journal | title = Tibial Anterior Compartment Syndrome | journal = StatPearls | date = 2020 | pmid = 30085512 | url = http://www.ncbi.nlm.nih.gov/books/NBK518970/ | access-date = 2020-01-31 | publisher = StatPearls Publishing | vauthors = Kiel J, Kaiser K }}

The pathophysiology of acute compartment syndrome in children is the same as adults.{{Citation |last=Hak |first=David J. |title=Acute Compartment Syndrome in Children |date=2019 |work=Compartment Syndrome |pages=125–132 |editor-last=Mauffrey |editor-first=Cyril |url=http://link.springer.com/10.1007/978-3-030-22331-1_13 |access-date=2025-01-28 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-030-22331-1_13 |pmid=32091730 |isbn=978-3-030-22330-4 |editor2-last=Hak |editor2-first=David J. |editor3-last=Martin III |editor3-first=Murphy P.}} However, cases are complicated by challenges in examination and communication with pediatric patients. Children may not be able to effectively report their pain symptoms.{{Cite journal |last1=Flynn |first1=John M |last2=Bashyal |first2=Ravi K |last3=Yeger-McKeever |first3=Meira |last4=Garner |first4=Matthew R |last5=Launay |first5=Franck |last6=Sponseller |first6=Paul D |date=May 2011 |title=Acute Traumatic Compartment Syndrome of the Leg in Children: Diagnosis and Outcome |url=http://journals.lww.com/00004623-201105180-00006 |journal=The Journal of Bone and Joint Surgery-American Volume |language=en |volume=93 |issue=10 |pages=937–941 |doi=10.2106/JBJS.J.00285 |pmid=21593369 |issn=0021-9355}} In addition, it can take longer to develop high pressures in pediatric compartments.{{Cite journal |last1=Livingston |first1=Kristin |last2=Glotzbecker |first2=Michael |last3=Miller |first3=Patricia E. |last4=Hresko |first4=Michael T. |last5=Hedequist |first5=Daniel |last6=Shore |first6=Benjamin J. |date=October 2016 |title=Pediatric Nonfracture Acute Compartment Syndrome: A Review of 39 Cases |url=https://journals.lww.com/01241398-201610000-00006 |journal=Journal of Pediatric Orthopaedics |language=en |volume=36 |issue=7 |pages=685–690 |doi=10.1097/BPO.0000000000000526 |pmid=26019026 |issn=0271-6798}} Besides the "5 Ps," the "3 As" can diagnose compartment syndrome in children: increasing anxiety, agitation, and analgesic needs.{{Cite journal |last1=Noonan |first1=Kenneth |last2=McCarthy |first2=James |date=September 2011 |title=Compartment Syndromes in the Pediatric Patient |url=https://doi.org/10.1097/01.bpo.0000405143.30083.85 |journal=Journal of Pediatric Orthopaedics |volume=31 |pages=ii |doi=10.1097/01.bpo.0000405143.30083.85 |issn=0271-6798}} Normal compartment pressures in children are typically higher than adults.{{Cite journal |last1=Staudt |first1=J. M. |last2=Smeulders |first2=M. J. C. |last3=van der Horst |first3=C. M. A. M. |date=February 2008 |title=Normal compartment pressures of the lower leg in children |url=https://online.boneandjoint.org.uk/doi/10.1302/0301-620X.90B2.19678 |journal=The Journal of Bone and Joint Surgery. British Volume |language=en |volume=90-B |issue=2 |pages=215–219 |doi=10.1302/0301-620X.90B2.19678 |pmid=18256091 |issn=0301-620X}} The most common cause of compartment syndrome in children is traumatic injury.{{Cite journal |last1=Mashru |first1=Rakesh P. |last2=Herman |first2=Martin J. |last3=Pizzutillo |first3=Peter D. |date=September 2005 |title=Tibial Shaft Fractures in Children and Adolescents |url=http://journals.lww.com/00124635-200509000-00008 |journal=Journal of the American Academy of Orthopaedic Surgeons |language=en |volume=13 |issue=5 |pages=345–352 |doi=10.5435/00124635-200509000-00008 |pmid=16148360 |issn=1067-151X}} In children <10 years of age, the cause is usually vascular injury or infection.{{Cite journal |last1=Shore |first1=Benjamin J. |last2=Glotzbecker |first2=Michael P. |last3=Zurakowski |first3=David |last4=Gelbard |first4=Estee |last5=Hedequist |first5=Daniel J. |last6=Matheney |first6=Travis H. |date=November 2013 |title=Acute Compartment Syndrome in Children and Teenagers With Tibial Shaft Fractures: Incidence and Multivariable Risk Factors |url=https://journals.lww.com/00005131-201311000-00006 |journal=Journal of Orthopaedic Trauma |language=en |volume=27 |issue=11 |pages=616–621 |doi=10.1097/BOT.0b013e31828f949c |pmid=23481923 |issn=0890-5339}} In children >14 years of age, the cause is usually due to trauma or surgical positioning. Treatment for compartment syndrome in children is the same as adults.

• Abdominal compartment syndrome
• Escharotomy
• Ischemia-reperfusion injury of the appendicular musculoskeletal system

{{Reflist}}

{{Commons category}}

• [https://www.orthopaedia.com/acute-compartment-syndrome/ Compartment Syndrome of the Forearm] – Orthopaedia.com
• [http://www.mayoclinic.com/health/chronic-exertional-compartment-syndrome/DS00789/DSECTION=symptoms Chronic Exertional Compartment Syndrome detailed at MayoClinic.com]
• {{DukeOrtho|Compartment_syndrome}}
• {{MerckHome|05|062|a}}
• [https://www.sportsinjurybulletin.com/anatomy/getting-a-leg-up-on-chronic-exertional-compartment-syndrome-in-the-deep-compartment Compartment syndrome]
• [https://orthoinfo.aaos.org/en/diseases--conditions/compartment-syndrome/ American Association of Orthopaedic Surgeons Compartment Syndrome]

{{Myopathy}}

{{Trauma |state=autocollapse}}

{{Medical resources

| DiseasesDB = 3028

| ICD11 = {{ICD11|NF0A.6}}

| ICD10 = {{ICD10|M|62|2|m|60}}, {{ICD10|T|79|6|t|79}}

| ICD9 = {{ICD9|729.7}}, {{ICD9|958.9}}

| ICDO =

| OMIM =

| MedlinePlus = 001224

| eMedicineSubj = emerg

| eMedicineTopic = 739

| MeshID = D003161

| SNOMED CT = 111245009

}}

{{Authority control}}

{{DEFAULTSORT:Compartment Syndrome}}

Category:Disorders of fascia

Category:Syndromes

Category:Early complications of trauma

Category:Causes of amputation

Category:Wikipedia medicine articles ready to translate

Category:Wikipedia emergency medicine articles ready to translate