Compartment syndrome (CS) occurs when pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia. The cycle of events leading to acute CS begins when tissue pressure exceeds venous pressure and impairs blood outflow. Lack of oxygenated blood and lack of waste product removal result in pain and decreased peripheral sensation secondary to nerve irritation. Late manifestations of CS include the absence of a distal pulse, hypoesthesia, and extremity paresis as the cycle of elevating tissue pressure eventually compromises arterial blood flow. Untreated, the muscles and nerve within the compartment undergo necrosis, and a limb contracture, called a Volkmann contracture (VC), results.

The compartments of the lower leg, foot, and the volar forearm are particularly prone to developing CS. The intrinsic muscle compartments of the hand and, less commonly, the upper arm may also be affected. The most common etiology of an upper extremity CS is a displaced supracondylar humerus fracture. The diagnosis is made on clinical examination when the physician has a high index of suspicion, and operative decompression is the definitive treatment. In the forearm, usually both volar and dorsal compartments are released.

Compartment pressure measurements are usually reserved for diagnosing chronic compartment syndrome (CCS), for evaluating comatose or anesthetized patients, or for situations in which the clinical examination findings are equivocal and the possibility of nonoperative management is likely. Some authors suggest documentation of compartment pressures in all cases, regardless of the clinical examination findings, yet others do not advocate measurement of compartment pressures when the findings on examination are clear and the patient is selected for surgery.

Morbidity and mortality from CS stem from a delay in treatment or diagnosis. After prolonged muscle ischemia, muscle necrosis results in scarring and contracture, named after von Volkmann who described the contracture in 1875. Rhabdomyolysis and subsequent renal failure are among the most severe complications. However, they usually have a self-limited course if treated appropriately.