The thigh can be divided into the anterior, posterior, and medial (or adductor) compartments. Although rarely seen compared with the lower leg muscles, each of these regions of the thigh is at risk for development of compartment syndrome. The most common etiologies are blunt or penetrating trauma, and many cases are associated with iatrogenic, acquired, or inherited coagulopathies. Diagnosis is based on the clinical examination and intracompartmental pressure measurements. Surgical decompression using a 2-incision technique is the treatment of choice, however, there is literature to support closely monitored conservative treatment in the carefully selected patient. Worse outcomes have been associated with ipsilateral femur fracture, delay in decompression >8 hours, and muscle necrosis at the time of surgery. Despite proper treatment, significant short-term and long-term morbidity are reported and include pain, weakness, limp and development of heterotopic ossification. We review the history, etiology, diagnosis, and surgical technique used in the treatment of thigh compartment syndrome.