Acute Compartment Syndrome

(ACS; Compartment Syndrome, Acute; Volkmann’s Ischemia)


Sheets of connective tissue called fascia are located under the skin of the arms and legs. These wrap around groups of muscles, nerves, and blood vessels to create a unit called a compartment. When pressure builds up in these enclosed spaces, it is redirected into the compartment. When pressure reaches a certain point, it disrupts blood flow. Blood vessels may fail and tissue dies. Acute compartment syndrome (ACS) can affect the arms, hands, legs, feet, and buttocks.
Compartment Syndrome in Lower Leg
Compartment Syndrome
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Common causes include:
  • Vein obstructions in the extremities
  • Hemorrhage
  • Complication of surgery

Risk Factors

Factors that may increase your chance of ACS include:
  • Pre-existing condition that could lead to fatal bleeding in cases of trauma, such as:
    • Taking anticoagulants
    • Having a bleeding disorder such as hemophilia
  • Participation in certain collision or contact sports such as football
  • Bandages or casts that are worn too tightly or worn for too long
  • Recent injury to the area
  • Burns
  • Swelling of tissues under the skin


ACS may cause:
  • Severe pain
  • Feeling of tightness or fullness of muscles
  • Swollen, pale, shiny skin over affected area
  • Numbness or tingling
Symptoms can develop within 30 minutes-2 hours. In other cases, it may take days.


You will be asked about your symptoms and medical history. A physical exam will be done.Your bodily fluids will be tested. This can be done with blood tests.Imaging tests to evaluate bodily structures may include:The pressure inside your compartments will be measured. This can be done with:
  • Slit catheter
  • Tonometer
  • Near-infrared spectroscopy

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