Structural anatomy of deep fascia, it’s implication in the pathogenesis of compartment syndrome of upper limbs and objective assessment of the effect of fasciotomy

Neeraj K. Agrawal, Preeti Agrawal, Rahul Dubepuria


Background: Deep fascia is dense and well developed in limbs. In the upper limb the deep fascia is tightly adherent to the underlying muscles especially in the forearm, thereby, restricting the space available to muscular swelling causing painful compartment syndrome. Division of this inelastic fascia or fasciotomy is an emergency procedure to decrease the morbidity and mortality.

Methods: 30 patients with acute compartment syndrome of the upper extremity of various aetiologies were studied. Adults with painful, swollen and tense upper extremities with progressive neurological dysfunction were studied. Compartment pressures before and after fasciotomy were measured by a standard Whiteside’s device. Various fasciotomies were carried out and associated skeletal and vascular injuries were also noted.

Results: The majority of patients were males with average age being 29.33 years. 56.67% patients with upper limb compartment syndrome sustained road traffic injury, 20% were constrictive tight cast, 20% of patients sustained burn and 1 patient was shot by bullet. Of the 30 patients fractures of both ulna and radius (40%) were the most common. Fractures of the humerus, radius, ulna and small bone of metacarpals together account for 36.67% of the affected patients. 3 patients were found to have injury to major vessels. Compartment pressure was measured by Whiteside’s device and fasciotomy resulted in a drastic drop of the pressure from pre-fasciotomy pressure of 44.8±7.9 mmHg to post-fasciotomy pressure of 12.33±3.61 mmHg.

Conclusions: The diagnosis of compartment syndrome should be confirmed swiftly and prompt fasciotomy is the treatment of choice. This offers the best chance at decreasing compartment pressure and preventing further damage.


Compartment pressure, Compartment syndrome, Deep fascia, Fasciotomy, Upper limb, Vascular injury

Full Text:



Mauser N, Gissel H, Henderson C, Hao J, Hak D, Mauffrey C. Acute lower-leg mentcompartment syndrome. Orthoped. 2013;36(8):619-24.

Via AG, Oliva F, Spoliti M, Maffulli N. Acute compartment syndrome. Muscles Ligaments Tendons J. 2015;5(1):18-22.

Standring S. Gray’s anatomy: The anatomical basis of clinical practice. 40th ed. Edinburgh, UK: Churchill Livingstone. 2008.

Findley T. Fascia research II: Second International Fascia Research Congress. Int J Ther Massage Bodywork. 2009;2(3):4-9.

Benjamin M. The fascia of the limbs and back - a review. J Anatomy. 2009;214(1):1-18.

Volkmann R. Ischemic muscle paralysis and contractures. Zentralbl Chir. 1881;8:801-3.

Willy C, Schneider P, Engelhardt M, Hargens AR, Mubarak SJ. Richard von Volkmann. Clin Orthop Rel Res. 2008;466(2):500-6.

Jones SG. Volkmann’s contracture. Am J Surg. 1939;43(2):325-37.

Thomas JJ. Nerve involvement in the ischaemic paralysis and contracture of Volkmann. Ann Surg. 1909;49:330-7.

Whitesides TE, Haney TC, Harada H, Holmes HE, Morimoto K. A simple method for tissue pressure determination. Arch Surg. 1975;110:1311-3.

Matsen FA, Mayo KA, Sheridan GW, Krugmire RB Jr. Monitoring of intramuscular pressure. Surgery. 1976;79:702-9.

Mubarak SJ, Hargens AR, Owen CA, Garetto LP, Akeson WH. The wick catheter technique for measurement of intramuscular pressure. J Bone Joint Surg. 1976;58A:1016-20.

Rorabeck C, Castle G, Hardie R, Logan J. Compartmental pressure measurements: an experimental investigation using the slit catheter. J Trauma. 1981;21:446-9.

Abraham P, Leftheriotis G, Saumet JL. Laser Doppler flowmetry in the diagnosis of chronic compartment syndrome. J Bone Joint Surg. 1998;80B:365-9.

Edwards PD, Miles KA, Owens SJ, Kemp PM, Jenner JR. A new non-invasive test for the detection of compartment syndromes. Nucl Med Commun. 1999;20:215-8.

Leversedge FJ, Moore TJ, Peterson BC, Seiler JG. Compartment Syndrome of the Upper Extremity. J Hand Surg. 2011;36(3):544-59.

Petersen F. Ueber ischamische muskellahmung. Arch Klin Chir. 1888;37:675-7.

Glass GG, Staruch RMT, Simmons J, Lawton G, Nanchahal J, Jain A, Hettiaratchy SP. Managing missed lower extremity compartment syndrome in the physiologically stable patient: a systematic review and lessons from a Level I trauma center. J Trauma Acute Care Surg. 2016;81(2):380-7.

Schwartz JT, Brumback RJ, Lakatos R, Poka A, Bathon GH, Burgess AR. Acute compartment syndrome of the thigh-a spectrum of injury. J Bone Joint Surg Am. 1989;71A(3):392-400.

Erdos J, Dlaska C, Szatmary P, Humenberger M, Vecsei V, Hajdu S. Acute compartment syndrome in children: a case series in 24 patients and review of the literature. Int Orthop. 2011;35:569-75.

Mubarak SJ, Carroll NC. Volkmann’s contracture in children: aetiology and prevention. J Bone Joint Surg. 1979;61B:285-93.

Eaton RG, Green WT. Volkmann’s ischemia: a volar compartment syndrome of the forearm. Clin Orthop. 1975;113:58-64.

Bajpai J, Sinha BN, Srivastava AN. Clinical study of Volkmann's ischemic contracture of the upper limb. Int Surg. 1975;60(3):162-4.

Stockley I, Harvey IA, Getty CJM. Acute volar compartment syndrome of the forearm secondary to fractures of the distal radius. Injury. 1988;19(2):101-4.

Anjaria DJ, Deitch EA. Burn Injury, Compartment Syndromes. In: Vincent JL, Hall JB, eds. Encyclopedia of Intensive Care Medicine, Berlin, Heidelberg: Springer. 2012.

Smith J, Bowyer M. Upper extremity fasciotomies. In: Demetriades D, Inaba K, Velmahos G, eds. Atlas of Surgical Techniques in Trauma. Cambridge: Cambridge University Press. 2015:288-93.

Whitesides TE, Haney TC, Morimoto K, Harada H. Tissue pressure measurements as a determinant for the need of fasciotomy. Clin Orthop Relat Res. 1975;113:43-51.

Mubarak SJ, Hargens AR. Acute compartment syndromes. Surg Clin North Am. 1983;63(3):539-65.

Olson SA, Glasgow RR. Acute compartment syndrome in lower extremity musculoskeletal trauma. J Am Acad Orthop Surg. 2005;13(7):436-44.

Percival TJ, White JM, Ricci MA. Compartment Syndrome in the Setting of Vascular Injury. Perspectives in Vascular Surgery and Endovascular Therapy. 2011;23(2):119-24.