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Case: A 26-year-old man presented to the emergency department with atraumatic right leg pain after a period of low-impact activity. He was discharged and returned 3 days later with findings of acute compartment syndrome., Conclusion: We present a case of delayed diagnosis of acute exertional compartment syndrome (AECS) in the setting of rhabdomyolysis, leading to detrimental sequelae. Practitioners with a high degree of clinical suspicion can make a prompt and accurate diagnosis by physical examination alone, allowing early treatment of AECS.

Chronic exertional compartment syndrome is an often overlooked and uncommon cause of pain in the extremities of individuals who engage in repetitive physical activity. A thorough history, a careful physical examination, and compartment pressure testing are essential to establish the diagnosis. Catheter measurements can provide useful information on baseline resting compartment pressures as well as compartment pressures after exercise or trauma. Patients with chronic exertional compartment syndrome usually do not respond to nonsurgical therapy other than completely ceasing the activities that cause the symptoms. Surgical intervention entails fasciotomies of the involved compartments. Although obtaining accurate compartment pressure measurements can be difficult and fascial releases must be done carefully, patients typically have satisfactory functional results and are able to return to their usual physical activities after fasciotomy.

The anterior and lateral compartmental syndromes of the leg due to intensive use of muscles can be briefly defined as painful circulatory disturbances associated with a pathological increase in total intramuscular pressure. In these syndromes, an acute and a chronic form are distinguished. The acute form takes a progressive course, and the structures within the compartment affected are subject to complete or partial destruction. The chronic form takes an intermittent course. Physical exertion of the lower limbs gives rise to pain in the compartment. Determination of the pressure in the tibialis anteriot muscle and phlebography, both before and after weighted exercise of the muscles of the anterior compartment, were found to be the most valuable diagnostic aids in the chronic syndrome. In the acute syndrome, the compartment affected must be decompressed by fasciotomy as quickly as possible. Since most patients with a chronic syndrome can adequately cope with daily requirements, an operation is not always required. Indications for fasciotomy are presented. The real cause of the increase in total intramuscular pressure is not understood, suggestions concerning the pathogenesis are made, and the mechanism of the circulatory disturbances is discussed.

A compartmental syndrome is defined as a condition in which increased pressure within a space compromises the circulation to the contents of that space. Any cause of increased intracompartmental pressure may result in a compartmental syndrome. The diagnosis should be suspected in any case of pain or neuromuscular deficit in an extremity and may be confirmed by signs of circulatory disturbance of nerve and muscle in association with increased pressure in the compartment. Generous opening of any dressings covering the extremity permits a proper examination and rules out a compartmental syndrome caused by the dressing itself. Immediate decompression is indicated in all cases of compartmental syndrome unless the risk of complications exceeds the possible gains from improvement in circulation. Elevation of an extremity afflicted with a compartmental syndrome is contraindicated. Myoglobinuria and renal failure may complicate severe cases.