Course Description:

Acute compartment syndrome (ACS) is a medical emergency that occurs when pressure increases within a closed space that is restricted by fascia, reducing or eliminating perfusion to the muscles and nerves within the space. It most often affects the lower leg, especially the anterior compartment, but can also affect the upper leg, foot, forearm, or any other area of the body that is limited by fascia. Tissue necrosis can result if ACS is not treated in a timely manner. Systemic involvement (e.g., kidney failure) can also occur. ACS is most often caused by a traumatic injury due to a motor vehicle accident, sports injury, crush injury, direct blow to the area, or fracture. Fracture is the cause in the majority of cases. Patients present with signs of compromise of neural and vascular function. The cardinal sign is pain out of proportion to the known injury and often resistant to analgesia. Typical signs are sometimes referred to as “the 5 Ps”: pain, paresthesia, paralysis, pallor, and pulselessness. Tightness in the compartment is often palpable, and passive stretch of the muscles in the compartment can be painful. Paralysis, pallor and pulselessness are often not evident until late in development of ACS. Physical therapy is not indicated. If ACS is suspected, the patient should immediately be sent to the emergency room for further evaluation and treatment. Surgical intervention involves fasciotomy of the affected compartment.