Classic
- The hallmark presentation is pain that is out of proportion to injury or findings.
- Patients will describe the pain as “deep”, “burning,” and “unrelenting” with difficulty in localization.
- Pain with passive stretching of the muscle groups or tightness of the compartment is also common.
- Compartment syndrome can occur when the compartment is seemingly open, such as open fractures and stab wounds.
- In trauma, the anterior compartment of the leg is the most common location of compartment syndrome; however, it is possible for it to occur in any extremity compartment.
- Symptoms commonly arise within 2 hours of injury but can also present up to 6 days later.
Presentation
Critical presentation
- The additional findings of paresthesias, anesthesia, paralysis, poikilothermia, and pulselessness are very late findings and should not be relied upon in the initial evaluation.
- It is estimated that muscles and nerves can tolerate ischemia for 4–6 hours without significant sequelae. After this there is risk of permanent nerve damage, myonecrosis and muscle contractures.
- After 8 hours, necrosis of tissue is certain and a nonfunctional limb is likely.
- Rarely, rhabdomyolysis, renal failure, and disseminated intravascular coagulation (DIC) can result from tissue necrosis secondary to the failure to relieve compartmental pressure.
- Delay in diagnosis correlates directly with worse outcomes.
Diagnosis and evaluation
- Physical examination is paramount as the physician must rely on clinical judgment for diagnosis. See the table below for lower leg compartment syndrome findings.
Lower leg compartment syndrome findings |
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General findings• Pain out of proportion to injury• Analgesia use out of proportion to injury |
Anterior compartment• Weakness of toe extension• Pain on passive toe flexion• Diminished sensation in the first web space |
Deep posterior compartment• Weakness of ankle inversion and toe flexion• Pain on passive toe extension referred to the posterior leg• Diminished sensation over medial sole of foot |

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