Acute Compartment Syndrome

Acute compartment syndrome is a painful condition that occurs when swelling and pressure build up suddenly in a body space (compartment). Groups of muscles, nerves, and blood vessels in the arms and legs are separated into various compartments. Each compartment is surrounded by tough layers of tissue called fascia. In compartment syndrome, pressure builds up within the layers of fascia and begins to push on the structures within that compartment. Compartment syndrome can occur in any muscle compartment of the body, but it is most common in the leg (below the knee) and in the arm (below the elbow).

In acute compartment syndrome, the sudden pressure that builds up is often because of an injury. If pressure continues to build, it can block the flow of blood in the smallest blood vessels (capillaries). As a result, the muscles in the compartment cannot get enough oxygen and nutrients and will start to die within 4–6 hours. The nerves will begin to die within 12–24 hours. This condition is a medical emergency, and it must be treated with surgery. If left untreated, this condition could result in permanent damage or loss of the leg or arm.

What are the causes?

This condition may be caused by:

  • Injury. Some injuries can cause swelling or bleeding in a compartment, and this can lead to compartment syndrome. Injuries that may cause this problem include:

    • Broken bones, especially the long bones of your arms and legs.

    • Crushing injuries.

    • Badly bruised muscles.

    • Injuries from something that penetratesthe body, such as a knife that causes a wound.

    • Severe burns.

    • Poisonous bites, such as a snake bite.

  • Blocked blood flow. Causes of blocked blood flow include:

    • A cast or bandage that is too tight.

    • A surgical procedure. Blood flow sometimes must be stopped for a while during a surgery, usually with a very tight device (tourniquet).

    • Lying for too long in a position that restricts blood flow. This can happen if you have nerve damage or if you are unconscious for a long time.

    • Anabolic steroids. These medicines are used to build up muscles.

    • Blood thinners. These medicines keep your blood from forming clots but can increase internal bleeding after an injury.

What are the signs or symptoms?

The main symptom of this condition is pain.

  • Pain may be far more severe than it should be for the injury you have.

  • Pain may get worse:

    • When moving or stretching the affected leg or arm.

    • When the area is pushed or squeezed.

    • When you raise (elevate) the affected area above the level of your heart.

  • Pain may come with a feeling of tingling or burning.

  • Pain may not get better when you take pain medicine.

Other symptoms include:

  • A feeling of tightness or fullness in the affected area.

  • Numbness.

  • Weakness in the affected area.

  • Loss of movement.

  • Skin becoming pale, tight, and shiny over the painful area.

  • Warmth and tenderness.

  • Tensing when the affected area is touched.

How is this diagnosed?

This condition may be diagnosed based on:

  • Your history and symptoms.

  • A physical exam.

  • Measuring the pressure in the affected area (compartment pressure measurement).

You may also have other tests, including:

  • X-rays.

  • Ultrasound.

How is this treated?

This condition is treated with a procedure called fasciotomy. This is an urgent procedure that is done as soon as possible to prevent muscle death. In this procedure, incisions are made through the fascia to relieve the pressure in the compartment and to restore blood flow to that area. This procedure helps to prevent permanent damage to the body part. Before the surgery, first-aid treatment is done, which may include:

  • Treating any injury.

  • Loosening or removing any splint, cast, bandage, or external wrap that may be causing pain.

  • Elevating the painful arm or leg to the same level as your heart.

  • Giving oxygen.

  • Giving fluids through an IV.

  • Giving pain medicine.


  • Compartment syndrome occurs when swelling and pressure build up in a body space (compartment). Compartment syndrome can occur in any muscle compartment of the body but is most common in the leg (below the knee) and in the arm (below the elbow).

  • In acute compartment syndrome, the pressure builds up suddenly, often because of an injury. This condition is a medical emergency.

  • Symptoms of acute compartment syndrome may include one or more of the following in the affected body part: severe pain, tingling or burning, weakness, loss of movement, or paleness.

  • First-aid treatment may include loosening or removing a splint, cast, bandage, or wrap. It may also include elevating your painful arm or leg to the same level as your heart.

  • Compartment syndrome must be treated with a surgical procedure called fasciotomy. This procedure relieves pressure, restores blood flow, and prevents permanent damage.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

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