Acute compartment syndrome of the deltoid: a case report and systematic review of the literature

Rarely Seen Compartment Syndrome of the Shoulder and Back: Diagnosis and Management

Compartment syndrome (CS) is a well-known surgical emergency with high morbidity including potential long-term disability and limb loss. The most important factor determining the degree of morbidity with CS is time to treatment; therefore, early diagnosis and surgery are vital. We present a patient who fell off his bicycle and sustained cervical spine fractures causing near complete quadriplegia. He was found by the road over 12 hours later, so his creatine phosphokinase (CPK) was trended and serial examinations were performed. We identified tight deltoid, trapezius, and latissimus compartments and brought him to the operating room for fasciotomies. Although lab values and compartment pressures can be helpful, they should not guide treatment. It is important to consider atypical sites for CS and complete a head to toe physical examination. Patients should proceed to the operating room if clinical suspicion exists for CS because of the morbidity associated with a missed diagnosis.

Complications of Lateral Decubitus Positioning During Orthopaedic Surgery

» Lateral decubitus positioning is a nonanatomical position used for multiple orthopaedic procedures to obtain adequate surgical exposure.» Unique ophthalmologic, musculoskeletal, neurovascular, and hemodynamic complications may arise inadvertently from positioning.» Orthopaedic surgeons should be aware of the possible complications that may manifest from placing patients in the lateral decubitus position to adequately prevent and to properly manage them.

Acute compartment syndrome of the contralateral thigh following reconstructive shoulder surgery done for multidirectional shoulder instability in lateral decubitus position

A man in his early 40s had revision reconstructive surgery on his left shoulder while in a right lateral decubitus position. The prolonged surgery (7 hours) caused acute compartment syndrome (ACS) in the contralateral (right) thigh. Moderate pain and swelling of the contralateral thigh ('well limb') was first noted in the recovery room. After progression to severe swelling and numbness in his right toes, fasciotomies of the right thigh were performed, confirming ACS. Thirteen months later he returned to his prior work without lower extremity discomfort or limitations, and he reported a good result from the revision shoulder surgery. Non-traumatic ACS of a well limb is a rare complication of surgery performed in the lateral decubitus position. We suggest that moving the patient temporarily, or to a new position (eg, beach chair), should be considered when the duration of surgery approaches 4.5 hours.

A case of sub-acute compartment syndrome of bilateral pectoralis major, deltoid and triceps muscles

A 19-year-old healthy bodybuilder presented to the emergency department with gradually worsening pain in both his upper arms and shoulders and inability to fully flex his elbows. The haematological investigations revealed a markedly raised Creatinine Kinase (74,400 U/L) and myoglobinuria. The patient required an emergency surgical decompression of the pectoral and the anterior and posterior compartments of arms of both upper limbs with secondary closure after 48 h. The patient had an uneventful post-op and recovery of his functions with some initial restriction of full flexion of his left elbow and some weakness in his triceps, all of which gradually improved.