Overview
what it is and why it mattersAcute compartment syndrome is a surgical emergency. Your muscles are organized into tightly-packaged groups (compartments) wrapped in a tough sheath of tissue that does not stretch. When pressure inside one of those compartments climbs higher than the small blood vessels can push against, blood flow to the muscle and nerve cuts off. Without surgery to release that pressure within about 4 to 6 hours, the muscle dies, and the consequences are permanent, such as a clawed, stiffened hand after a forearm injury or a foot that cannot lift after a leg injury.
Compartment syndrome can follow a fracture, a crush injury, a burn, or even a cast that ends up too tight. Doctors once taught a longer list of warning signs, but most of those show up too late to be useful. The two earliest, most reliable warnings: pain that is out of proportion to the injury, and severe pain when someone gently stretches the muscles in the affected limb.
If compartment syndrome is suspected
This is a surgical emergency. Do not delay, call (830) 625-0009 or proceed immediately to the nearest emergency department.
Symptoms
what you may noticeThe hallmark is pain that is out of proportion to the visible injury. A forearm or lower leg that should hurt moderately after a fracture instead produces severe, deep, unrelenting pain that does not respond to the usual doses of pain medication. The limb feels tense and swollen, hard to the touch rather than soft, and the skin may look shiny and stretched.
The single most reliable early warning sign comes from gently stretching the muscle: if someone gently extends your fingers or toes and the pain in the affected compartment spikes dramatically, that points strongly toward rising compartment pressure. Late signs, numbness, inability to move the fingers or toes, pale or dusky skin, and absent pulse, mean irreversible damage may already be underway. Do not wait for those to appear before seeking emergency care.
Diagnosis
exam first, imaging secondWhen the clinical picture raises suspicion, your surgeon measures the actual pressure inside the compartment using a needle device. When that pressure is too high relative to your blood pressure, emergency surgery is needed. Do not wait for the pulse to disappear. That is a very late sign, and it means the artery itself is being squeezed off, well past the point of reversible damage.
How We Treat It
how care progresses, in orderThere is no slow, build-up plan here. Compartment syndrome is a surgical emergency, so treatment moves quickly and in a set order. The first step is to take pressure off the limb; if that is not enough, surgery follows without delay.
1
Loosen Anything That Is Squeezing the Limb
If the pressure is coming from a cast or a tight wrapping, the very first step is to cut and open all of it right away. When a too-tight cast is the only cause, opening it may be enough on its own.
2
Move Straight to Emergency Surgery if the Pressure Stays High
If opening the dressings does not bring the pressure down, or the warning signs are clear from the start, the next step is emergency surgery to release the pressure. Because muscle can die within about 4 to 6 hours, this is done without waiting. The surgery itself is described in the next section.
Surgical Options
if non-operative care isn't enoughOnce the pressure threshold is met (or when the clinical signs are unmistakable but a patient can't communicate well enough for the bedside exam), an emergency fasciotomy is performed without delay, the surgeon makes long incisions through the tough sheath that wraps the muscle compartment, releasing the pressure and restoring blood flow.
Providers Who Treat Compartment Syndrome
trauma team
Frequently Asked
questions we hear in clinicHow quickly does this need to be treated?
Very quickly. Compartment syndrome is a surgical emergency. Without surgery to release the pressure within about 4 to 6 hours, the muscle dies and the damage is permanent. That is why suspected cases go straight to the emergency department rather than waiting for a routine appointment.
What are the earliest warning signs?
The two earliest and most reliable warnings are pain that is way out of proportion to the injury, and severe pain when someone passively stretches the muscles in the affected limb. The limb also tends to feel tense and swollen, hard to the touch rather than soft, with skin that may look shiny and stretched.
Why not wait for numbness or a missing pulse?
Because those are late signs. Numbness, the inability to move the fingers or toes, pale or dusky skin, and an absent pulse mean irreversible damage may already be underway. A missing pulse in particular means the artery itself is being squeezed off, well past the point of reversible damage. The goal is to act on the early warnings, not to wait for the late ones to appear.
What can cause compartment syndrome?
It can follow a fracture, a crush injury, a burn, or even a cast that ends up too tight. When a too-tight cast is the only cause, opening the cast may be enough to relieve the pressure.
How is it diagnosed?
When the clinical picture raises suspicion, the surgeon measures the actual pressure inside the compartment using a needle device. When that pressure is too high relative to your blood pressure, emergency surgery is needed.
What does the surgery involve?
The emergency surgery is called a fasciotomy. The surgeon makes long incisions through the tough sheath that wraps the muscle compartment, releasing the pressure and restoring blood flow.
Further Reading
authoritative sourcesExternal patient-education references and related OSI pages for additional background: