Under local anaesthetic, the tip of an 18G Venflon was placed in the muscle compartment and then taped to the forearm. Diagnosis was confirmed by dynamic compartment pressure monitoring pre- and immediately post-exertion once symptoms had come on in both superficial flexor and dorsal extensor compartments. All six were unable to continue with their normal training and were no longer able to compete.Ĭlinically, all rowers had normal muscle bulk, normal pulses and no evidence of a peripheral nerve entrapment. All described bilateral symptoms of pain affecting both the flexor and extensor compartments, loss of grip strength and altered sensation in the hands within 2–5 min of commencing full racing pressure or 15–20 min of steady-state rowing with complete resolution at rest. Six elite rowers competing at the national and international levels were referred with features suggestive of CECS of the forearm. More recently, some authors have also suggested accepting a rise of 10 mmHg with exertion regardless of baseline. Pressure testing in CECS is considered positive if any of the following are found: resting pressure (P) > 15 mmHg, 1 min post-exercise P > 30 mmHg or 5 min post-exercise P > 20 mmHg. Confirmation of the diagnosis is made using intra-compartmental pressure monitoring in multiple compartments before, during and after exercise. Symptoms must resolve completely between periods of activity and are typically bilateral. ĭiagnosis of CECS of the forearm is initially made on a classical symptom history of pain in the forearm, loss of grip strength and altered sensation in the hands brought on by activity. It has been most reported in competitive motorcycling where it is known as ‘arm pump’, but other sports include gymnastics and hockey, wheelchair athletics and climbing, water skiing, kayaking and non-sporting activities such as carpentry and manual work. Patients are usually involved in activities with repetitive isometric muscle loading of the wrist while gripping. We present a safe technique used with six elite rowers for mini-open fasciotomy to minimise scarring and time away from training while reducing the risk of neurovascular injury.Ĭhronic exertional compartment syndrome (CECS) of the forearm is a rare but increasingly well recognised condition possibly first described in 1983. Minimally invasive techniques have been described (Croutzet et al., Tech Hand Up Extrem Surg 13(3):137–40, 2009) but have a risk of neuro-vascular injury, especially to the ulnar nerve while releasing the deep flexor compartment. With no effective medical treatment, the gold standard remains four compartment open fasciotomy (Söderberg, J Bone Joint Surg Br 78(5):780–2, 1996 Wasilewski and Asdourian, Am J Sports Med 19(6):665–7, 1991). The condition is self-limiting and resolves completely between periods of activity. Typical symptoms are pain, distal paraesthesia and loss of function. CECS is a function of increasing pressure following muscle expansion within an inelastic tissue envelope resulting in compromise of perfusion and tissue function. Chronic exertional compartment syndrome (CECS) of the forearm may occur in sports requiring prolonged grip strength.
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