What is "acute compartment syndrome" and why did it lead to Miles O'Brien losing an arm?

Miles O’Brien, former CNN science guy, currently with PBS, was loading some boxes while on assignment. One of the boxes fell on his arm, but it didn’t seem like a major injury.

Two days later, his doctor had to amputate his arm above the elbow, because of ‘acute compartment syndrome.’

What is acute compartment syndrome, and why can it have such serious consequences?

Basically from reading Wikipedia, acute compartment syndrome is a situation where due to trauma, muscles and other tissues swell severely within a certain body “compartment” bounded by relatively inflexible and inexpandable tissues. This causes restricted blood flow and nerve and muscle damage.

Usually treatment involves a fasciotomy; compartment syndrome is increased pressure due to bleeding/swelling in a compartment. From the link you posted a case fell on his arm, which would definitely be a cause;

Amputation may be needed in some cases, especially when not treated immediately;

Just a few months ago, I actually took care of a guy who had compartment syndrome of his leg. Numerous drugs were involved in how he got it, but the upshot was that surgery had to come and do a fasciotomy (giant incision through the various compartments from his buttocks down to his knee) and then we had to watch him all night to make sure that the balance between relieving the pressure and blood loss didn’t tip too far either way. Actually ended up requiring numerous blood transfusions and he eventually went back to the OR. I’m not sure what ended up happening after that since he left the medical ICU and went to the surgical ICU post-surgery, but he could easily have lost his entire leg if he hadn’t gotten treatment in time.

Basically what it means is the “compartment” of muscles through which blood vessels and nerve bundles pass is too narrow and this causes a buildup of pressure when any strenuous activity is performed with that muscle group.

I had extreme pain walking and my doctor had me walk on a treadmill to the point pain began, and then inserted a pressure gauge directly into the muscles to read the pressure. The reading was alarmingly high, thus confirming this syndrome.

Permanent relief comes when surgery is performed to “open” the narrow compartment. A severe, acute case can lead to blood flow disruption leading to amputation.

(Am I the only one who saw the thread title and thought “Damn, I don’t remember that episode”?)


Me neither, but I didn’t want to be first to say it. Dr. Bashir wouldn’t have needed to amputate it.

ISTR BJ Hunnicut receiving this kind of injury on MAS*H when the autoclave exploded. They had to bring in a hand specialist to operate on him, who everyone hated for some reason.

I knew I did not recall the episode where this happened.

How much Brien was amputated?

Miles O’Brien.

Ohhh, that’s a low blow.
Attacking an unarmed man.