Forearm Chronic Exertional Compartment Syndrome
What are the forearm compartments?
The muscles and tissue of the forearm are divided into 3 main compartments (volar, dorsal, mobile wad). Dividing these compartments is relatively inelastic connective tissue called fascia.
What is chronic exertional compartment syndrome and its symptoms?
During exercise, muscles normally swell and enlarge (hypertrophy). These enlarged muscles normally return to a baseline size within a few minutes following the cessation of activity. Given the fascia dividing the compartments is relatively inelastic, the swelling can cause increased pressure within the fascial compartments. If high enough, this pressure compresses the blood vessels and nerves traveling in these compartments, ultimately causing a temporary lack of oxygen and nutrients to the tissues. The resulting symptoms are pain, weak grip, loss of hand/wrist function, numbness, and tingling. Symptoms tend to resolve a few minutes after the patient stops exercising. This rapid reversal of symptoms upon stopping exercise is a hallmark of the disorder. It is important to note that the disorder is most common in patients involved in activities requiring prolonged, repetitive gripping motions with short periods of rest. Rowers are the classic patient. Symptoms furthermore tend to recur even after extended periods of activity modification and training cessation.
The patient’s clinical history is by far the most important factor for diagnosis. X-rays and MRI may be ordered to rule out other pathology. Intracompartmental pressure measurements may also be recommended to confirm the diagnosis. A needle is inserted into the fascial compartments during these measurements. This needle is attached to a small electronic machine that calculates the pressure within the compartments. These measurements are ideally done before, during, and after exercise. An Electromyogram (EMG) study, which assesses the health of nerves and the muscles they control, may be ordered if the patient has neurological symptoms.
Nonoperative management involves activity modification and stopping the aggravating activity or sport. This option is often not a viable one for elite athletes however.
Surgical management involves a procedure called a fasciotomy. In this procedure, the fascial compartments are opened, allowing more room for the muscles to enlarge during exercise. This surgery typically takes Dr. Steven Lee less than 20 minutes to perform, and is done in an outpatient setting.
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Patients are usually instructed to begin physical therapy one week following surgery. The patient is usually allowed to return to progressive activities as tolerated once incisions are healed. Patients generally return to full activity/sports 4-6 weeks after surgery. While most patients experience complete resolution of symptoms after fasciotomy, some patients may not experience complete relief from the procedure.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.