Skip to Main Content


The ability to diagnose a compartment syndrome is a critical skill for the Emergency Physician. Early identification of a compartment syndrome can enable the appropriate treatment and may facilitate limb salvage. A compartment syndrome begins when an imbalance of volume and pressure within a myofascial compartment results in diminished blood flow.1 A compartment syndrome has been classically described in the early literature as a Volkmann ischemic contracture following vascular insufficiency in the forearm.3


A compartment syndrome can occur in almost any muscle group that is contained within a confined fascial space. Common locations include the leg, forearm, and gluteal area. There are many causes of a compartment syndrome. These include protracted muscle ischemia (secondary to necrosis from a contusion), swelling (secondary to volume overload states or a fracture), or a thrombus in a vessel that traverses the compartment. In the Emergency Department, a compartment syndrome is most commonly associated with long bone fractures or blunt trauma.2 Other etiologies for a compartment syndrome include complications from a coagulopathy, dialysis, surgery, or states of obtundation.4–6


Identifying a compartment syndrome in a timely fashion can be challenging. The hallmark symptom is persistent and progressive pain that is disproportionate to the underlying cause. The pain typically increases with passive motion. A catastrophic mistake is to attribute the etiology of the patient’s pain solely to the underlying problem, such as the fracture.7,8 Other signs and symptoms associated with a compartment syndrome occur late in the course and include paresthesias of the involved nerve, paralysis of the involved muscle group, pallor of the skin, and diminished pulses.9 Waiting for the development of all the clinical signs and symptoms is an invitation for permanent and dangerous sequelae, including muscle necrosis and possible loss of a limb. Measurement of elevated tissue pressure within the muscle compartment is currently the most common objective means of diagnosing this syndrome. The compartment pressure must be released by performing an emergent fasciotomy of the involved compartments once a compartment syndrome is identified.


The anatomy of a compartment syndrome is variable, as it can occur in any enclosed muscle group. Any muscle tissue that is confined in space by fascia, skin, or any external forces (e.g., casting material) is a potential site for the development of a compartment syndrome. The muscles, nerves, and vasculature within the affected muscle group are all potentially compromised by a prolonged ischemic state followed by swelling.


The initial imbalance of a compartment syndrome occurs between the volume and pressure within the myofascial compartment. The arterial inflow and venous outflow diminish as either intracompartmental volume or pressure increases. The blood begins to be shunted via capillaries into the muscle tissue. This compensatory shunting of blood further disturbs the volume-pressure balance, resulting in impaired tissue oxygenation.2,9,10


The extent of the tissue damage is determined by the duration of ischemia. ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessEmergency Medicine Full Site: One-Year Subscription

Connect to the full suite of AccessEmergency Medicine content and resources including advanced 8th edition chapters of Tintinalli’s, high-quality procedural videos and images, interactive board review, an integrated drug database, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessEmergency Medicine

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.