Characteristics and Outcomes of Patients Who Undergo Fasciotomy for Acute Upper Arm Compartment Syndrome

Woman holding upper arm, ache and pain concept

Acute compartment syndrome (ACS) of the upper arm requires prompt diagnosis and emergent fasciotomy. In this potentially devastating disorder, increased pressures within closed fascial compartments result in decreased capillary perfusion pressure and compromised tissue viability. Delays in treatment can result in neurologic deficits, musculotendinous contractures, or limb amputation.

Acute upper arm compartment syndrome is rare, and little has been published about it. Dafang Zhang, MD, of the Department of Orthopaedic Surgery at Brigham and Women’s Hospital, and colleagues recently described patient characteristics and outcomes in the European Journal of Orthopaedic Surgery & Traumatology.


The researchers identified 15 adults who underwent fasciotomy for ACS of the upper arm at the Brigham or Massachusetts General Hospital between January 1, 2006, and June 30, 2015. In the healthcare system’s Research Patient Data Registry, there was 100% data completeness for all variables reported in this summary.

Demographic and Clinical Characteristics

Key characteristics noted on presentation were:

  • Mean age—52 years
  • Sex—11 men
  • Active smoking—1 patient
  • Diabetes mellitus—2 patients
  • Average international normalized ratios (INR)—2.0 (reference range, 0.9–1.1)
  • INR above the reference range—11 patients
  • INR above 1.5—5 patients

Mechanisms of Injury

The causative mechanisms of injury varied widely:

  • Blunt trauma (n=3)
  • Vascular injury (n=3)
  • Infection related to intravenous drug use (n=2)
  • Sequela of tumor resection (n=2)
  • Burn (n=1)
  • Penetrating injury (n=1)
  • Spontaneous bleeding (n=1)
  • Sports injury (n=1)
  • Traumatic biceps rupture (n=1)


The treatment characteristics reported were:

  • Number of operations per patient—median, 1; range, 1–6
  • Anterior compartment released—13 patients
  • Posterior compartment released—4 patients
  • Need for split-thickness skin graft—2 patients

The time from injury to surgery was bimodal: four patients underwent fasciotomy within six hours after injury, whereas seven waited more than 24 hours. Delays were not invariably associated with worse outcomes.


Six patients had no major deficits after surgery. Of the others:

  • 3 had persistent neuropathies
  • 3 had elbow contracture (one had difficulty lifting light or heavy objects)
  • 1 had no elbow contracture but reported difficulty lifting heavy objects
  • 2 were lost to follow-up

Guidance for Patient Care

Physicians should note that ACS of the upper arm was seen across varying patient demographics and injury mechanisms. The frequency of elevated INR suggests intracompartmental bleeding may be a common cause. Clinicians should also remember that acute upper arm compartment syndrome can develop in the common clinical scenarios of blunt trauma, vascular injuries, and oncologic resection.

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