Compartment syndrome occurs when increased pressure within a
limited space compromises the circulation and function of the tissues
within that space. It was first described in 1881 by Richard Van
Volkmann, a German physician who noted that paralysis and contractures
were the late sequela of an interruption of the blood supply to
the muscles in the forearm. In 1924, it was shown that the result
could be prevented by prompt surgical decompression of the compartment.
Today, a high degree of clinical suspicion, coupled with timely
surgery, can be used to retain function of the muscles and nerves
that are at risk of permanent damage from elevated compartment pressures.
The borders of a confined space are often made up of bone or
tissue that offers minimal capacity to stretch. Any increase in
volume within that compartment results in an elevated intracompartmental
pressure. In the lower extremity, the most common site is at the
level of the tibia and fibula, where 40% of compartment
syndromes occur. The lower leg has four compartments: anterior,
lateral, superficial posterior, and deep posterior (Figure
275-1). Also see Figure 272-1 in Chapter 272, Leg Injuries.
The four compartments of the leg.
The upper leg has three compartments: anterior, posterior, and
medial. Due to the larger size of these compartments and their interconnectivity, they
are less predisposed to elevated tissue pressures. The foot and
buttock region of the leg also have a lower incidence of compartment
In the upper extremity, the forearm has three compartments: flexor,
extensor, and mobile wad (Figures 275-2 and 275-3). These are the high risk areas in
the arm. The hand (Figure 275-4) or upper
arm (Figure 275-5) are less likely to develop
a compartment syndrome.
Forearm compartments: transverse sections through the
right forearm at various levels.
Hand compartments: transverse section through the right
The biceps-brachialis (anterior) and
triceps (posterior) compartments of the right arm.
Muscle death and nerve damage in the setting of compartment syndrome
are caused by prolonged elevation of tissue pressures. This can
result from external forces, such as a cast or tight dressing, that
compress a compartment. It can also result from an increase in the
volume of a compartment that exceeds the limits of the surrounding
fascia’s ability to stretch. This may be the ...