Forearm Compartment Syndrome

Compartment syndrome in all extremities is an orthopedic emergency.


Compartment syndrome in all extremities is an orthopedic emergency.

Forearm compartment syndrome occurs as a result of

  • A major crushing injury
  • Burn or injection injury to the forearm causing the pressure within the three forearm compartments to exceed the ability of the blood pressure generated by the heart’s pumping action to supply sufficient blood flow to the elbow and forearm. When this occurs, the muscles and nerves within the compartment are at risk of dying with little or no chance of recovery

A fracture may or may not accompany a forearm compartment syndrome. In most cases, a wound is not present, potentially indirectly decompressing the forearm compartments preventing the pressure buildup.

Patients with forearm compartment syndrome complain of pain that is out of proportion to the injury. As the pain increases, the patient demands for a subsequent increase in pain medication.

This is a dangerous situation. Ignoring the increasing pressure in the compartments will result in tissue death and potential loss of the limb.

Symptoms of Compartment Syndrome

  • Numbness
  • Tingling
  • Tense forearm
  • Pain with straightening the fingers
  • Loss of sensation in the forearm and hand accompanied by a cool sensation of the skin
  • Changes in skin color
  • Final loss of pulse in wrist, which is a final sign preceding tissue death
  • No symptoms at all if the compartment syndrome has gone too long and the nerves protective functions have been suppressed. Tissue death then follows

Because the signs and symptoms can be variable, physicians must have a high index of suspicion of this condition. More pain medication is not the answer. Increasing pain after an injury requires direct clinical evaluation by your doctor and should not be addressed over the phone.


If an elbow, forearm and hand compartment syndrome is diagnosed, it must be treated within 6 hours of occurrence.

Diagnosis is done clinically, and with the use of compartment pressure measurement instruments. If there is conflicting findings between the clinical presentation and the measurement obtained, it is prudent to follow the clinical findings to avoid the catastrophe of tissue death if the measuring device is wrong.

The treatment of a compartment syndrome consists of releasing the connective tissue (fascia) that surrounds and separates each compartment.

The release relieves the pressure within the compartment and allows the muscles and nerves within the compartment to receive their required blood supply.

The surgical wounds are often not sutured back immediately to allow the skin and soft tissue to accommodate any swelling. The wound either undergoes a delayed closure or skin is grafted to accommodate the increased swelling. If the wounds cannot be closed because of skin tightness, another technique is to use a vacuum-assisted wound closure device.