# Atypical Presentation of Acute Compartment Syndrome in the Lower Limb: A Case Report of When Pain Does Not Guide the Diagnosis

## TL;DR

A patient with no pain after a serious injury was diagnosed with a life-threatening muscle condition, showing the need for careful evaluation beyond just pain.

## Contribution

This case report highlights the atypical presentation of acute compartment syndrome without pain, emphasizing the importance of clinical suspicion and early intervention.

## Key findings

- A 42-year-old male developed silent compartment syndrome after a motorcycle collision without experiencing significant pain.
- Diagnosis was confirmed through invasive pressure measurements and led to urgent surgical intervention.
- The case underscores the need for clinicians to suspect ACS even when pain is absent in trauma patients.

## Abstract

Acute compartment syndrome (ACS) is a surgical emergency that, if not promptly treated, can lead to muscle necrosis, limb loss, or death. Although disproportionate pain is traditionally considered the hallmark symptom, atypical presentations without pain have been described. We report the case of a 42-year-old male who sustained multiple traumatic injuries in a motorcycle-vehicle collision and subsequently developed silent compartment syndrome in the left thigh and leg. Despite being conscious and neurologically intact, the patient did not report significant pain at any point. The diagnosis was suspected based on objective findings, including tense edema, absent distal pulses, and progressive motor dysfunction. Invasive compartment pressure measurements confirmed the diagnosis, leading to urgent fasciotomies and intensive care management, including renal replacement therapy. This case highlights the importance of maintaining a high index of suspicion for ACS in patients with major trauma, even in the absence of pain, and supports early intervention to prevent irreversible sequelae.