Acute Compartment Syndrome

Unrecognized or improperly treated acute compartment syndrome can cause serious injury, including limb loss and even death.  As a result, it is the underlying medical condition in many medical malpractice lawsuits.

Our bodies have a number of muscle compartments, which are separated by fascia, a tough, inelastic, fibrous sheet.  Acute compartment syndrome occurs when swelling creates pressure inside one of the compartments.  The inelasticity of the fascia surrounding the compartment prevents the pressure from escaping.  If the pressure reaches a certain point, it prevents or severely reduces the ability of the body to deliver blood to the compartment.  The absence of blood flow (ischemia) will cause tissue damage and, if it persists long enough, tissue death.

Acute compartment syndrome after minor trauma in a patient with undiagnosed mild haemophilia B - The Lancet

The images above show the before and after of acute compartment syndrome.  Note the swelling in image A.  Image B shows a reduced size after surgery to relieve the pressure.  Acute compartment syndrome is a surgical emergency and the window during which surgery can be successfully performed to reduce the compartment pressure is generally considered to be no more than six hours after onset.  After that point in time, permanent muscle damage is likely.  If tissue death occurs before the pressure can be relieved, amputation of the affected limb may be necessary.

Acute compartment syndrome is most often caused by trauma.  The usual causal mechanism is a fracture of one of the long bones in the arm or leg but it can also be caused by a crush injury that does not result in a bone fracture as well as some other conditions.  While most commonly found in the legs or arms, it can also occur in the buttock, shoulder, hand, or foot.  Any condition that can cause a sudden swelling in a compartment can set the stage for acute compartment syndrome.

The diagnosis of acute compartment syndrome is a clinical one, that is, the diagnosis is usually made on the basis of the patient’s symptoms.  There are no good tests for it.  One of the dangerous characteristics of acute compartment syndrome is that it may not appear for as much as 48 hours after the traumatic injury.

The symptoms commonly found in acute compartment syndrome are pain, paresthesia (numbness and tingling), pallor, pulselessness, and paralysis.  The pain associated with this condition is usually severe and seemingly out of proportion to the underlying injury.  Unfortunately, most of the symptoms of acute compartment syndrome are late findings, that is they don’t show up until late in the process.  The earliest finding is almost always a tense compartment that is frequently described as feeling “woody.”

Because of the emergent nature of acute compartment syndrome, doctors encountering patients who might be at risk for it should be concerned it might develop and be watchful for symptoms.  At the earliest sign of a developing syndrome, they should call for an emergency surgical consultation.  They must also recognize that, even if not immediately present, the condition may develop in the coming hours.  It is important, therefore, that the patient be instructed about what to watch out for and to return immediately, if any of the symptoms of a developing compartment syndrome appear.

The occurrence of an acute compartment syndrome presents many opportunities for medical providers to make mistakes and, if its presence is missed, the risk of a very serious injury.  If you have suffered an injury due to acute compartment syndrome for which you sought medical treatment, you may have been the victim of medical malpractice.  You should consult with an experienced malpractice lawyer, who can review your medical records and advise you whether you have a claim that can be successfully pursued.


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