Skip to content

Clinicians › Hand

Compartment Syndrome of the Upper Limb

64 citationsUpdated Oct 2026
Illustration: hand

Overview

Acute compartment syndrome is a rare but serious condition affecting the upper extremity, including the upper arm, forearm, and hand [1, 7]. It results from decreased compartment size or increased compartment content [6]. Early recognition and prompt surgical decompression are essential to prevent irreversible muscle and nerve damage, myonecrosis, contracture, and limb dysfunction [3, 4, 7]. Minimizing the time to fasciotomy is critical to optimize patient outcomes [3]. Adequate decompression of the 10 anatomic compartments of the hand is necessary at the time of fasciotomy [3]. While acute cases require emergent intervention, chronic compartment syndrome of the upper extremity is rare but should be considered in patients with appropriate history [5]. Diagnosis of chronic cases is aided by intramuscular pressure measurement and MRI before and after load, whereas angiography is not helpful [5].

The condition may arise from various etiologies, including suction injuries, ischemia from extended external pressure on the supraspinatus, scapula, and trapezius compartment, and phlegmasia cerulea dolens [2, 20, 23]. It can also occur in newborns, transferred muscles, and following crush injuries [12, 14, 27, 39]. In cases of multiple extremity involvement, surgeons should consider systemic disorders such as SCLS and treat both the compartment syndrome and the underlying disease [29]. Although a tourniquet used for 90 minutes does not appear to put the limb at risk [26], revascularization may contribute to crush syndrome due to reperfusion injury, raising doubts about mandatory surgical intervention in specific contexts [53].

Treatment options vary by acuity and patient profile. Endoscopic fasciotomy is considered the gold standard for chronic exertional compartment syndrome of the forearm and is the first choice for young sportsmen with anterior or posterior compartment syndromes [25, 40]. This technique is described as simple, reliable, and reproducible [11]. For acute cases, forearm fasciotomy of the relevant compartment is performed to decompress the area and gain a good functional outcome [15]. Early postoperative rehabilitation following suction injuries has provided favorable functional outcomes [2]. Recurrent compartment syndrome can occur even after complete release for crush injury [12].

Anatomy & Pathophysiology

Anatomical Distribution and Prevalence

Acute compartment syndrome is common in the leg but relatively rare in the upper limb [45]. In the upper extremity, it occurs most frequently in the forearm as a result of skeletal or vascular trauma [13]. While compartment syndromes have been recognized for many years in the calf and forearm compartments [21], clinicians must recognize that acute compartment syndrome can also occur in the upper arm, rather than only the forearm and leg [1]. It has become evident that compartment syndrome can occur in the upper arm, buttock, and thigh [21]. This condition is rare and generally occurs acutely in compartments of the legs and forearms [24]. Within the hand, compartment syndrome is rarer in the first dorsal interosseous space [24] and extremely rare in the thenar compartments [24].

Etiology and Mechanisms

Compartment syndromes in either the arm or the forearm, or both, may result from prolonged localized external compression, as seen in crush syndrome [13]. Localized compartment syndrome of the arm can also occur following a prolonged surgical procedure on the forearm and hand performed under pneumatic tourniquet control [13]. In children, suction injuries can lead to acute compartment syndrome of the interosseous muscle of the hand [2]. Ischaemic contracture of the intrinsic muscles of the hands can be a hazard of physical restraint [10]. Heavy compression of the wrist can disrupt the osseofibrous tunnel at several points, resulting in an acute compartment syndrome of the wrist and forearm [110].

Forearm compartment syndrome is often accompanied by the presence of fracture, especially of the distal radius [45]. Approximately 70% of forearm acute compartment syndrome cases are caused by the presence of fractures [45], while acute compartment syndrome without fracture occurs in about 30% of cases [45]. Closed muscle rupture with acute compartment syndrome of the forearm is uncommon [45].

Pathophysiology

In chronic compartment syndrome, one hypothesis for pathophysiology relates to an abnormal container, where muscle fascia is thickened or remodeled because of microtrauma and becomes fibrotic [24]. Another hypothesis relates to abnormal contents, where muscles non-physiologically increase in volume during exertion by more than 20% [24]. Increased pressure in a compartment leads to reduced venous return and tissue ischemia secondary to a reduced arteriovenous pressure gradient [24]. The ischemia caused by increased compartment pressure is generally reversible once the exertion stops [24]. The normal pressure in a muscle compartment before, immediately after, and 10 minutes after exertion is below 15 mmHg, 30 mmHg, and 15 mmHg, respectively [24]. When a limb affected by compartment syndrome is not adequately decompressed at an early stage, a different set of problems arises [21].

Anatomical Structures and Compartments

The hand contains 10 anatomic compartments that require adequate decompression at the time of fasciotomy [3]. The extrinsic extensors run through six different fibroosseous retinacular compartments at the wrist level [42]: * First extensor compartment: Contains the abductor pollicis longus and the extensor pollicis brevis [42]. * Second extensor compartment: Contains the extensor carpi radialis longus and the extensor carpi radialis brevis [42]. * Third compartment: Contains the extensor pollicis longus [42]. * Fourth extensor compartment: Contains the extensor indicis proprius lying deep to the four tendons of the extensor digitorum communis [42]. * Fifth compartment: Contains the extensor digiti quinti [42]. * Sixth compartment: Contains the extensor carpi ulnaris tendon [42].

There are seven interosseous muscles in the hand, consisting of four dorsal and three volar muscles [57]. The dorsal interossei are abductors and lie to the radial side of the index and middle fingers and the ulnar side of the middle and ring fingers [57]. The volar interossei are adductors and lie to the ulnar side of the index finger and the radial side of the ring and little fingers [57]. The middle finger has two dorsal interossei and no volar interossei because the central axis of the hand lies within it [57].

The flexor digitorum profundus and the flexor pollicis longus muscles form the deep compartment of the volar forearm [64]. The flexor digitorum profundus and flexor pollicis longus tendons occupy the floor of the carpal tunnel [64]. The superficial palmar fascia lies in a coronal plane beneath the palmar subcutaneous tissue and covers a triangular area of the central palm [67]. The skeleton of the hand and wrist consists of 27 bones, of which 19 are long bones [43]. The hand consists of 19 bones, 17 articulations, and 19 muscles situated entirely within the hand [55].

Classification

Pathophysiological Mechanisms: Upper extremity compartment syndrome causes are categorized into decreased compartment size and increased compartment content [6]. Two pathophysiological hypotheses for chronic compartment syndrome are an abnormal container (fibrotic fascia) and abnormal contents (muscle volume increase >20% during exertion) [24].

Anatomic Distribution: Compartment syndromes in the upper extremity occur most frequently in the forearm as a result of skeletal or vascular trauma [13]. Acute compartment syndrome of the upper arm can occur and is distinct from the more common locations of the forearm and leg [1]. Compartment syndrome may occur in the upper arm, buttock, and thigh, in addition to the calf and forearm [21]. The deep flexor compartment of the forearm is a discrete entity that can be involved in chronic compartment syndrome [16]. The pronator quadratus compartment has clear anatomic definitions that may be useful in diagnosing compartment syndrome [48]. Chronic compartment syndrome is rarer in the first dorsal interosseous space of the hand and extremely rare in the thenar compartments [24]. Bilateral chronic compartment syndrome of the thenar muscles is a rare condition with only three previously described cases in published studies prior to the 2015 report [24].

Etiological Categories: Compartment syndromes in the arm or forearm may result from prolonged localized external compression, such as crush syndrome [13]. Compartment syndrome of the arm can be a complication of pneumatic tourniquet use during surgical procedures [13]. Ischaemic contracture of the intrinsic muscles of the hands can result from physical restraint [10]. Recurrent compartment syndrome of the hand can occur following complete compartment release for a crush injury [12]. Phlegmasia cerulea dolens of the upper extremity is associated with compartment syndrome [23]. Systemic disorders, such as Systemic Capillary Leak Syndrome (SCLS), can be associated with multiple extremity compartment syndrome [29]. Neuroleptic malignant syndrome can cause bilateral forearm compartment syndromes characterized by elevated compartment pressures and muscle necrosis [30].

Clinical Phenotypes: Acute compartment syndrome of the upper extremity is a rare but serious condition requiring prompt diagnosis and emergent fasciotomy [7]. Chronic compartment syndrome of the upper extremity is a rare condition that should be considered with appropriate history [5]. Chronic exertional compartment syndrome of the forearm flexor muscles is a distinct entity that may be missed if there is a low index of suspicion for exertional pain [8]. Acute exertional compartment syndrome of the upper extremity is a rare but real condition [9]. Compartment syndromes involving the interosseous muscles can be missed and treated symptomatically for many years, leading to a chronic course [17, 18]. Chronic compartment syndrome in the anconeus should be considered in the differential diagnosis of lateral elbow pain [35]. Compartment syndrome should be considered in the differential diagnosis of a neonate who is unable to move an extremity [37].

Other Considerations: The demographics of acute hand compartment syndrome have evolved in the last 25 years, partly due to the opioid epidemic leading to a rise in 'found down' compartment syndrome [28]. The 'found down' patient represents a separate subset of traumatic rhabdomyolysis distinct from other cases of Crush Syndrome [91]. Traumatic conditions resulting in measurable rhabdomyolysis, including Crush Syndrome (CrushS) and Compartment Syndrome (CS), can be classified based on mechanism, ischemia time, and presence or absence of CS [91]. Late Compartment Syndrome has a distinct presentation and outcomes from acute Compartment Syndrome with a contrasting treatment approach [91]. Normal pressure in a muscle compartment is below 15 mmHg before exertion, 30 mmHg immediately after exertion, and 15 mmHg 10 minutes after exertion [24].

Clinical Presentation

General Recognition and Rarity

Acute compartment syndrome of the upper extremity is a rare but serious condition [7]. Compartment syndromes in the upper extremity occur most frequently in the forearm [13]. The condition is rarer in the first dorsal interosseous space of the hand and extremely rare in the thenar compartments [24].

Diagnostic Challenges and Symptoms

The most common symptom of compartment syndrome is pain, which is nonspecific, particularly when it occurs in a clinical setting where severe pain is expected [32]. Other signs and symptoms are frequently nonspecific, leading surgeons to delay definitive treatment [32]. If fasciotomy is performed only after complete paralysis has occurred, permanent functional damage may already be significant [32]. In the upper extremity, any functional residual deficits may have severe consequences [32].

A high index of suspicion is required to recognize the signs and symptoms of compartment syndrome in patients on prolonged anticoagulation who suffer even trivial trauma [38]. The diagnosis should be considered in patients with familial rhabdomyolysis who develop myalgia, swelling, and muscle weakness [73]. Hereditary angioedema must be considered when patients present with compartment syndrome of the upper extremity of unknown etiology [71]. When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders such as systemic capillary leak syndrome [29]. In patients with lateral elbow pain, chronic compartment syndrome in the anconeus should be considered a possibility in the differential diagnosis [35]. Although uncommon, compartment syndrome should be considered in the differential diagnosis of the neonate who is unable to move an extremity [37].

Physical Findings and Signs

Visible swelling, palpable tenseness, and maximum pain with passive stretching of the muscles are typical findings of compartment syndrome [34]. Normal pulses and capillary filling time can be present in compartment syndrome [34]. The absence of a sensory deficit is a constant finding in compartment syndromes of the dorsal forearm [34]. Physical signs and surgical intervention are important in the late management of compartment syndromes when the limb is not adequately decompressed at an early stage [21].

Etiology and Risk Factors

Approximately 70% of acute forearm compartment syndrome cases are caused by the presence of fractures [45]. Acute forearm compartment syndrome without fracture occurs in about 30% of cases [45]. Two hypotheses for the pathophysiology of chronic compartment syndrome are an abnormal container (thickened or fibrotic fascia) and abnormal contents (muscles increasing in volume by more than 20% during exertion) [24]. Increased pressure in chronic compartment syndrome leads to reduced venous return and tissue ischemia, which is generally reversible once exertion stops [24].

Bilateral forearm compartment syndromes can develop as a complication of neuroleptic malignant syndrome, characterized by elevated compartment pressures and muscle necrosis [30]. Forearm compartment syndrome can be secondary to leukemic infiltrates [46]. A traumatized vascular hamartoma can produce a forearm flexor compartment syndrome [49]. Brachial muscle injury can result in acute compartment syndrome of the upper arm [1]. Acute exertional compartment syndrome of the upper extremity can occur after activities such as a push-up contest [9]. Chronic exertional compartment syndrome of the forearm flexor muscles is associated with exertional pain [8]. Chronic compartment syndrome of the upper extremity can occur in motocross riders [5]. A localized compartment syndrome of the arm can occur following a prolonged surgical procedure on the forearm and hand performed under pneumatic tourniquet control [13].

Diagnostic Modalities

Diagnosis of chronic compartment syndrome is aided by intramuscular pressure measurement and MRI before and after load [5]. Angiography is not helpful in the diagnosis of chronic compartment syndrome of the upper extremity [5]. Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome [47]. Objective methods for determining the presence of increased compartmental pressure have come into practice recently [32]. Clear anatomic definitions of the pronator quadratus compartment may be useful in diagnosis based on pressure measurements made using specific techniques [48].

Investigations

Clinical Assessment: Acute compartment syndrome of the upper extremity is a rare but serious condition requiring prompt diagnosis to prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction [7]. Clinicians must recognize that this condition can occur in the upper arm, not only the forearm and leg, to avoid missed diagnosis [1]. In neonates who are unable to move an extremity, compartment syndrome should be considered in the differential diagnosis [37]. A careful physical examination is essential to direct care and future testing if indicated, as diagnostic tests can be expensive, time consuming, and often nonspecific [41]. For chronic exertional compartment syndrome, a greater index of suspicion in a patient with exertional pain might lead to earlier diagnosis and definitive treatment [8]. The deep flexor compartment is a discrete entity that should be emphasized in the diagnosis of chronic compartment syndrome [16]. Excessive reliance on manometric techniques may lead to failure to recognize subtle varieties of the compartment syndrome, such as localized ischemic necrosis in the deep compartment [84].

Pressure Measurement: Diagnosis of chronic compartment syndrome is aided by intramuscular pressure measurement [5]. A greater index of suspicion in a patient with exertional pain might have led to earlier intramuscular pressure measurement [8]. If signs suggestive of compartment syndrome develop after operation, prompt intracompartment pressure measurements are indicated [94]. The normal pressure in a muscle compartment before, immediately after and 10 minutes after the exertion is below 15 mmHg, 30 mmHg, and 15 mmHg, respectively [24].

MRI: Diagnosis of chronic compartment syndrome is aided by MRI before and after load [5].

Other Considerations: ICG-based fluorescence imaging may serve as a valuable adjunct for guiding surgical debridement, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome [54].

Treatment

Acute Compartment Syndrome

Acute compartment syndrome of the upper extremity requires prompt diagnosis and emergent fasciotomy to optimize patient outcomes and prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction [7]. Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation of suction injuries leading to acute compartment syndrome of the hand provided a favorable and functional outcome [2]. In a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad) [52]. ICG-based fluorescence imaging may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome [54]. Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome [81]. Administration of antivenin is the currently recommended mainstay of treatment for snakebites in the upper extremity, with judicious application of surgical intervention in cases concerning for compartment syndrome, tissue necrosis, and limb compromise [82].

Chronic Compartment Syndrome

When symptoms persist despite conservative treatment (stretching, warm-up, correction of driving posture), the only non-surgical option to alleviate symptoms is to limit exertion [76]. Surgical treatment for chronic exertional compartment syndrome consists in preventive decompression of the compartment by fasciotomy [76]. Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm [31].

Late Management and Sequelae

When the limb affected by the compartment syndrome is not adequately decompressed at an early stage, a different set of problems arises in late management [21]. Division of the tendons of the contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the first web improved hand function in cases of ischaemic contracture [10]. Two patients were left with residual problems after resolution of the compartment syndrome despite early surgical intervention in one of these cases [33].

Complications

Missed or Delayed Diagnosis: Acute compartment syndrome is not limited to the forearm and leg; it can occur in the upper arm, where missed diagnosis carries serious consequences [1]. Delay in recognition and treatment of upper arm compartment syndrome can lead to irreversible muscle and nerve damage [4]. In the upper extremity, any functional residual deficits from compartment syndrome may have severe consequences [32]. The diagnosis may be missed in initial examinations, as documented in a patient with exercise-induced dorsal forearm compartment syndrome [34].

Tissue and Functional Damage: If not treated promptly, acute upper extremity compartment syndrome can result in myonecrosis, contracture, and limb dysfunction [7]. Ischaemic contracture of the intrinsic muscles of the hand can occur as a hazard of physical restraint [10]. Patients with compartment syndrome resulting from intravenous regional anesthesia may be left with residual problems despite early surgical intervention [33]. Additionally, biceps rupture in a patient on long-term anticoagulation can lead to compartment syndrome and nerve palsies [77].

Recurrence and Unusual Etiologies: Spontaneous compartment syndrome can occur in patients on long-term anticoagulation who suffer even trivial trauma [38]. Compartment syndrome of the forearm can be the initial symptom of systemic Vibrio vulnificus infection [85]. Acute compartment syndrome of the supraspinatus may be caused by ischemia resulting from the application of external pressure for an extended period of time on a compartment formed by the supraspinatus, scapula, and trapezius [20]. Compartment syndrome of the arm can also be a complication of the pneumatic tourniquet [13].

Impact on Outcomes and Management: Minimizing the time to surgical decompression is critical to optimize patient outcome in compartment syndrome [3]. Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation for suction-induced hand compartment syndrome provided a favorable and functional outcome [2]. Fasciotomy performed less than twelve hours after the onset of acute compartment syndrome resulted in normal function in 68 per cent of the extremities [74]. Only 8 per cent of extremities having late fasciotomy had normal function [74]. The complication rates for early and late fasciotomized extremities were 4.5 per cent and 54 per cent, respectively [74]. No significant differences in residual function or complication rate were noted with "open" or "closed" fasciotomy [74]. Division of the tendons of contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the first web improved hand function in cases of ischaemic contracture [10].

Recovery

Other Considerations: Delay in the treatment of compartment syndrome in the upper arm can lead to irreversible muscle and nerve damage [4]. If a fasciotomy is performed only after complete paralysis has occurred, permanent functional damage may already be significant [32]. In cases of ischaemic contracture, division of the tendons of contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the first web improved hand function [10]. Endoscopic fasciotomy should be considered the gold standard treatment for chronic exertional compartment syndrome of the forearm [25]. Complete recovery followed a 48-hour interval between the onset of symptoms and decompressive fasciotomy in a case of exercise-induced dorsal forearm compartment syndrome [34]. Two patients were left with residual problems after resolution of compartment syndrome resulting from intravenous regional anesthesia, despite early surgical intervention in one of these cases [33].

Key Evidence

  • [Case_report] Clinicians should fully recognize that acute compartment syndrome can occur in the upper arm, rather than only the forearm and leg, to avoid serious consequences caused by missed diagnosis and misdiagnosis. [1] (10.1186/s12891-021-04318-1)
  • [L4] Early diagnosis, prompt surgical decompression, and early postoperative rehabilitation of this unusual etiology of compartment syndrome of the hand provided a favorable and functional outcome. [2] (10.1016/s0363-5023(96)80025-6)
  • [L5] Minimizing the time to surgical decompression in a patient diagnosed with compartment syndrome is critical to optimize patient outcome, and adequate decompression of the 10 anatomic compartments of the hand is necessary at the time of fasciotomy. [3] (10.1016/j.hcl.2017.09.005)
  • [L5] Early recognition and treatment of compartment syndrome in the upper arm is essential, as delay can lead to irreversible muscle and nerve damage. [4] (10.1016/0266-7681(94)90151-1)
  • [L4] Chronic compartment syndrome of the upper extremity is rare but should be considered with appropriate history; diagnosis is aided by intramuscular pressure measurement and MRI before and after load, while angiography is not helpful. [5] (10.1055/s-2006-923785)
  • [L5] This article describes the various causes of upper extremity compartment syndrome, categorizing them into decreased compartment size and increased compartment content. [6] (10.1016/s0749-0712(21)00395-4)
  • [L5] Acute compartment syndrome of the upper extremity is a rare but serious condition requiring prompt diagnosis and emergent fasciotomy to optimize patient outcomes and prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction. [7] (10.1016/j.jhsa.2025.07.021)
  • [L5] An appreciation of chronic exertional compartment syndrome of the upper extremity and a greater index of suspicion in a patient with exertional pain might have led to earlier intramuscular pressure measurement and definitive treatment with decompressive fasciotomy. [8] (10.1016/s0363-5023(88)80126-6)
  • [L5] Acute exertional compartment syndrome (AECS) of the upper extremity is a rare but real condition that must be taken seriously. [9] (10.5435/jaaosglobal-d-19-00017)
  • [L5] Division of the tendons of the contracted interosseous muscles proximal to the metacarpophalangeal joints and release of the left first web improved hand function. [10] (10.1016/0266-7681(86)90016-1)
  • [L4] Endoscopic release of chronic forearm compartment syndromes is a simple, reliable, and reproducible technique. [11] (10.1016/j.main.2013.10.099)
  • [L5] We present an unusual case involving recurrent compartment syndrome of the hand in a patient who underwent complete compartment release for a crush injury 5 weeks earlier. [12] (10.1016/s0363-5023(98)80091-9)
  • [Case_report] [13] (10.2106/00004623-198466040-00027)
  • [L4] Forearm compartment syndrome in the newborn is not as uncommon as previously thought. [14] (10.1016/j.jhsa.2005.06.003)
  • [L5] Forearm fasciotomy of the relevant compartment should be performed to decompress the compartment and gain a good functional outcome. [15] (10.1016/s0020-1383(02)00304-2)
  • [L5] This case illustrates an unusual cause and location of a chronic compartment syndrome and emphasises the importance of the deep flexor compartment as a discrete entity. [16] (10.1016/0266-7681(89)90014-4)
  • [L5] Compartment syndromes involving the interosseous muscles can be missed and treated symptomatically for many years, leading to a chronic course. [17] (10.1016/0266-7681(87)90031-3)
  • [L5] Compartment syndromes involving the interosseous muscles can be missed and treated symptomatically for many years, leading to a chronic course. [18] (10.1016/0266-7681_87_90031-3)
  • [L5] The compartment syndrome may have been caused by ischemia resulting from the application of external pressure for an extended period of time on a compartment formed by the supraspinatus, scapula, and trapezius. [20] (10.1067/mse.2000.103617)
  • [L4] [21] (10.1016/0020-1383(95)00112-m)
  • [Case_report] Phlegmasia cerulea dolens of the upper extremity should raise the clinician's concern for an associated compartment syndrome. [23] (10.1016/j.jhsa.2009.08.003)
  • [L5] [24] (10.1016/j.main.2015.06.002)
  • [L4] In conclusion we presume that endoscopic fasciotomy, as treatment of chronic exertional compartment syndrome of the forearm should be considered as the gold standard treatment. [25] (10.1142/s2424835516400026)
  • [Paper] The use of a tourniquet for 90 minutes, with or without various forms of bandaging, does not appear to put the limb at risk of a compartment syndrome. [26] (10.1016/0266-7681(91)90061-r)
  • [L4] The paper highlights the importance of recognizing forearm compartment syndrome in the newborn, a rare condition that may be limb saving with proper treatment. [27] (10.1016/j.jhsa.2006.07.013)
  • [L4] The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in 'found down' compartment syndrome. [28] (10.1177/15589447221084012)
  • [L4] When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders, such as SCLS, and aggressively treat the compartment syndrome as well as the underlying disease. [29] (10.1007/s11552-010-9305-5)
  • [L5] The patient developed bilateral forearm compartment syndromes as a complication of neuroleptic malignant syndrome, characterized by elevated compartment pressures and muscle necrosis. [30] (10.1016/s0363-5023(96)80121-3)
  • [L4] Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm. [31] (10.1177/1753193410397900)
  • [L4] [32] (10.1016/s0363-5023(79)80160-4)
  • [L4] Two patients were left with residual problems after resolution of the compartment syndrome despite early surgical intervention in one of these cases. [33] (10.1016/s0363-5023(87)80208-3)
  • [L5] [34] (10.1016/s0363-5023(84)80205-1)
  • [L5] In patients with lateral elbow pain, chronic compartment syndrome in the anconeus should be considered a possibility in the differential diagnosis. [35] (10.1053/jhsu.2000.9422)
  • [L4] Although uncommon, compartment syndrome should be considered in the differential diagnosis of the neonate who is unable to move an extremity. [37] (10.1016/0363-5023(92)90401-a)
  • [L5] A high index of suspicion is required to recognize the signs and symptoms of compartment syndrome in patients on prolonged anticoagulation who suffer even trivial trauma and whose anticoagulation is well controlled. [38] (10.1016/0266-7681(93)90193-j)
  • [L4] Compartment syndrome of a transferred muscle is a real complication. [39] (10.1016/0266-7681(91)90134-a)
  • [L4] It is our first choice indication in young sportsmen for syndromes of the forearm (anterior and/or posterior compartment). [40] (10.1016/s1297-3203(03)00060-x)
  • [L4] [45] (10.1142/s0218810417500423)
  • [L5] Early diagnosis of the lesion, and possibly treatment with chemotherapy and radiation, might have made it possible to prevent the compartment syndrome. [46] (10.1016/s0363-5023(87)80209-5)
  • [L3] Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome. [47] (10.1177/1558944719884662)
  • [L5] These clear anatomic definitions might be useful in diagnosis of compartment syndrome of the pronator quadratus; a clinical investigation may be justified on the basis of pressure measurements made using this technique. [48] (10.1053/jhsu.2001.26656)
  • [L5] A case report is presented of a traumatized vascular hamartoma producing a forearm flexor compartment syndrome; such a case has not been reported previously. [49] (10.1016/s0363-5023(84)80077-5)
  • [L5] In a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad). [52] (10.1016/j.injury.2012.08.006)
  • [L5] The authors argue that mandatory surgical intervention for compartment syndrome is in doubt and that revascularization may contribute to crush syndrome due to reperfusion injury. [53] (10.1016/0020-1383(94)90169-4)
  • [L4] This technique may serve as a valuable adjunct for guiding surgical debridement which may minimize complications and reduce the number of debridement procedures required, particularly in challenging cases of delayed or missed diagnosis of compartment syndrome. [54] (10.1016/j.injury.2026.113039)
  • [Case_report] Hereditary angioedema is a rare but known cause of compartment syndrome of the upper extremity and must be considered when patients present with compartment syndrome of unknown etiology. [71] (10.1177/1558944716668830)
  • [L5] The diagnosis of compartment syndrome should be considered in patients with familial rhabdomyolysis who develop myalgia, swelling, and muscle weakness. [73] (10.2106/00004623-200211000-00021)
  • [L4] [74] (10.2106/00004623-197658010-00020)
  • [L4] [76] (10.1016/j.hansur.2020.01.011)
  • [L5] [77] (10.1016/s0266-7681(97)80415-9)
  • [L4] Conservative tangential excision represents an effective method for both the prevention and treatment of heat-induced compartment syndrome. [81] (10.1016/j.injury.2024.112069)
  • [L4] Administration of antivenin is the currently recommended mainstay of treatment, with judicious application of surgical intervention in cases concerning for compartment syndrome, tissue necrosis, and limb compromise. [82] (10.1016/j.jhsa.2018.06.016)
  • [L5] Excessive reliance on manometric techniques may lead to failure to recognize subtle varieties of the compartment syndrome, such as localized ischemic necrosis in the deep compartment. [84] (10.1016/s0363-5023(80)80023-2)
  • [L5] In evaluating a patient with compartment syndrome of unknown etiology, the surgeon should inquire about the patient’s medical history to determine whether it is consistent with V vulnificus exposure so that early and aggressive surgical intervention can be implemented. [85] (10.1053/jhsu.1999.0715)
  • [L5] [91] (10.5435/jaaos-d-23-00734)
  • [L5] If signs suggestive of compartment syndrome develop after operation, prompt intracompartment pressure measurements are indicated. [94] (10.1016/s0363-5023(89)80097-8)
  • [L5] The heavy compression of the wrist disrupted the osseofibrous tunnel at several points, resulting in an acute compartment syndrome of the wrist and forearm. [110] (10.1016/0266-7681(86)90261-5)

References

[1] Brachial muscle injury resulting in acute compartment syndrome of the upper arm: a case report and literature review. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04318-1

[2] Suction injuries in children leading to acute compartment syndrome of the interosseous muscle of the hand: case reports. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80025-6

[3] Hand Compartment Syndrome. Hand Clinics. 2018. DOI: 10.1016/j.hcl.2017.09.005

[4] Compartment Syndrome of the Arm. Journal of Hand Surgery. 1994. DOI: 10.1016/0266-7681(94)90151-1

[5] Chronisches Kompartmentsyndrom der Unterarmbeuger beim Motocrossfahren. Handchirurgie · Mikrochirurgie · Plastische Chirurgie. 2006. DOI: 10.1055/s-2006-923785

[6] CAUSES OF UPPER EXTREMITY COMPARTMENT SYNDROME. Hand Clinics. 1998. DOI: 10.1016/s0749-0712(21)00395-4

[7] Acute Compartment Syndrome of the Upper Extremity. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.07.021

[8] Chronic exertional compartment syndrome of the forearm flexor muscles. The Journal of Hand Surgery. 1988. DOI: 10.1016/s0363-5023(88)80126-6

[9] Acute Exertional Compartment Syndrome of Bilateral Upper Extremities After a Push-up Contest. JAAOS: Global Research and Reviews. 2019. DOI: 10.5435/jaaosglobal-d-19-00017

[10] Ischaemic contracture of the intrinsic muscles of the hands a hazard of physical restraint. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1986. DOI: 10.1016/0266-7681(86)90016-1

[11] Évaluation au long cours de l’aponévrotomie endoscopique dans le syndrome compartimental chronique d’avant bras. À propos de 72 cas. Chirurgie de la Main. 2013. DOI: 10.1016/j.main.2013.10.099

[12] Recurrent compartment syndrome of the hand: A case report. The Journal of Hand Surgery. 1998. DOI: 10.1016/s0363-5023(98)80091-9

[13] Compartment Syndrome of the Arm - A Complication of the Pneumatic Tourniquet. A Case Report. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466040-00027

[14] Forearm Compartment Syndrome in the Newborn: Report of 24 Cases. The Journal of Hand Surgery. 2005. DOI: 10.1016/j.jhsa.2005.06.003

[15] Unexplained bilateral extensor and unilateral flexor acute compartment syndrome of the forearm. Injury. 2004. DOI: 10.1016/s0020-1383(02)00304-2

[16] Chronic Compartment Syndrome of the Flexor Muscles in the Forearm: A Case Report. Journal of Hand Surgery. 1989. DOI: 10.1016/0266-7681(89)90014-4

[17] First dorsal interosseous compartment syndrome. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1987. DOI: 10.1016/0266-7681(87)90031-3

[18] First Dorsal Interosseous Compartment Syndrome. Journal of Hand Surgery. 1987. DOI: 10.1016/0266-7681_87_90031-3

[20] Acute compartment syndrome of the supraspinatus: A case report. Journal of Shoulder and Elbow Surgery. 2000. DOI: 10.1067/mse.2000.103617

[21] Late management of compartment syndromes. Injury. 1995. DOI: 10.1016/0020-1383(95)00112-m

[23] Upper Extremity Compartment Syndrome in the Setting of Deep Venous Thrombosis and Phlegmasia Cerulea Dolens: Case Report. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.08.003

[24] Bilateral chronic compartment syndrome of the thenar muscles: A case report. Chirurgie de la Main. 2015. DOI: 10.1016/j.main.2015.06.002

[25] Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long Term Follow-up. The Journal of Hand Surgery (Asian-Pacific Volume). 2016. DOI: 10.1142/s2424835516400026

[26] The Effect of Tourniquet Release on Intra-Compartmental Pressure in the Bandaged and Unbandaged Limb. Journal of Hand Surgery. 1991. DOI: 10.1016/0266-7681(91)90061-r

[27] Forearm Compartment Syndrome in the Newborn. The Journal of Hand Surgery. 2006. DOI: 10.1016/j.jhsa.2006.07.013

[28] Surgical Demographics of Acute Hand Compartment Syndrome. HAND. 2022. DOI: 10.1177/15589447221084012

[29] Compartment Syndrome in all Four Extremities: A Rare Case Associated with Systemic Capillary Leak Syndrome. HAND. 2010. DOI: 10.1007/s11552-010-9305-5

[30] Bilateral forearm compartment syndromes resulting from neuroleptic malignant syndrome. The Journal of Hand Surgery. 1996. DOI: 10.1016/s0363-5023(96)80121-3

[31] Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410397900

[32] Compartment syndromes of the forearm: Early recognition using tissue pressure measurements. The Journal of Hand Surgery. 1979. DOI: 10.1016/s0363-5023(79)80160-4

[33] Compartment syndrome resulting from intravenous regional anesthesia. The Journal of Hand Surgery. 1987. DOI: 10.1016/s0363-5023(87)80208-3

[34] An exercise-induced compartment syndrome of the dorsal forearm—A case report. The Journal of Hand Surgery. 1984. DOI: 10.1016/s0363-5023(84)80205-1

[35] Chronic anconeus compartment syndrome: A case report. The Journal of Hand Surgery. 2000. DOI: 10.1053/jhsu.2000.9422

[37] Neonatal compartment syndrome. The Journal of Hand Surgery. 1992. DOI: 10.1016/0363-5023(92)90401-a

[38] Spontaneous Compartment Syndrome in a Patient on Long-Term Anticoagulation. Journal of Hand Surgery. 1993. DOI: 10.1016/0266-7681(93)90193-j

[39] Compartment Syndrome in Transferred Muscle: an Unusual Complication. Journal of Hand Surgery. 1991. DOI: 10.1016/0266-7681(91)90134-a

[40] L’aponévrotomie endoscopique dans les syndromes de loges chroniques d’effort à l’avant-bras : à propos de 41 cas. Chirurgie de la Main. 2003. DOI: 10.1016/s1297-3203(03)00060-x

[41] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[42] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[43] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

[45] Acute Compartment Syndrome of Upper Extremities with Tendon Ruptures. The Journal of Hand Surgery (Asian-Pacific Volume). 2017. DOI: 10.1142/s0218810417500423

[46] Forearm compartment syndrome secondary to leukemic infiltrates. The Journal of Hand Surgery. 1987. DOI: 10.1016/s0363-5023(87)80209-5

[47] Factors Associated With Poor Outcomes in Acute Forearm Compartment Syndrome. HAND. 2019. DOI: 10.1177/1558944719884662

[48] Anatomy and intracompartmental pressure measurement technique of the pronator quadratus compartment. The Journal of Hand Surgery. 2001. DOI: 10.1053/jhsu.2001.26656

[49] Compartment syndrome caused by a traumatized vascular hamartoma. The Journal of Hand Surgery. 1984. DOI: 10.1016/s0363-5023(84)80077-5

[52] A single volar incision fasciotomy will decompress all three forearm compartments: A cadaver study. Injury. 2012. DOI: 10.1016/j.injury.2012.08.006

[53] Cortical bone screws. Injury. 1994. DOI: 10.1016/0020-1383(94)90169-4

[54] ICG-based fluorescence imaging to assess muscle perfusion for guiding surgical debridement after acute compartment syndrome. Injury. 2026. DOI: 10.1016/j.injury.2026.113039

[55] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[57] Green S Operative Hand Surgery. Interosseous and Hypothenar Muscles.

[64] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

[67] Green S Operative Hand Surgery. PERTINENT ANATOMY.

[71] Pediatric Hereditary Angioedema as a Cause of Acute Compartment Syndrome of the Hand and Forearm: A Case Report. HAND. 2016. DOI: 10.1177/1558944716668830

[73] COMPARTMENT SYNDROME IN A PATIENT WITH FAMILIAL RHABDOMYOLYSIS. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200211000-00021

[74] Fasciotomy in the treatment of the acute compartment syndrome. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00020

[76] Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: Clinical results of a new technique using an endoscopic carpal tunnel release device. Hand Surgery and Rehabilitation. 2020. DOI: 10.1016/j.hansur.2020.01.011

[77] Biceps Rupture in a Patient on Long-Term Anticoagulation Leading to Compartment Syndrome and Nerve Palsies. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80415-9

[81] Conservative tangential excision instead of escharotomy in the treatment of compartment syndrome. Injury. 2025. DOI: 10.1016/j.injury.2024.112069

[82] Management of Snakebites in the Upper Extremity. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.016

[84] Diagnosis of compartment syndromes of the forearm. The Journal of Hand Surgery. 1980. DOI: 10.1016/s0363-5023(80)80023-2

[85] Compartment Syndrome of the Forearm as the Initial Symptom of Systemic Vibrio vulnificus Infection. The Journal of Hand Surgery. 1999. DOI: 10.1053/jhsu.1999.0715

[91] Traumatic Rhabdomyolysis: Crush Syndrome, Compartment Syndrome, and the ‘Found Down’ Patient. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00734

[94] Transient compartment syndrome of the forearm resulting from venous congestion from a tourniquet. The Journal of Hand Surgery. 1989. DOI: 10.1016/s0363-5023(89)80097-8

[110] Fracture of the body of the hamate bone associated with compartment syndrome and dorsal decompression of the carpal tunnel. The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand. 1986. DOI: 10.1016/0266-7681(86)90261-5

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.