1
|
Facon JB, Mainard N, Louis P, Faure PA, Cognet JM. Ultrasound-guided fasciotomy in forearm chronic exertional compartment syndrome: Preliminary results in 12 cases. HAND SURGERY & REHABILITATION 2024:101719. [PMID: 38782365 DOI: 10.1016/j.hansur.2024.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Forearm chronic exertional compartment syndrome is a rare condition in athletes and musicians who perform repeated prolonged forced gripping movements. It mainly affects young men, and presents with cramp-like pain, beginning on the anteromedial side of the forearm and progressively extending to the entire circumference, and may be associated with muscle weakness and neurologic symptoms. The objective of this study was to report preliminary results of ultrasound-guided fasciotomy in the treatment of forearm chronic exertional compartment syndrome. MATERIAL AND METHODS A single-center retrospective observational study was conducted. Forearm chronic exertional compartment syndrome was diagnosed on clinical presentation and pathological intramuscular pressure measurement, defined as >30 mmHg at 1 min after effort. The series comprised 7 men, with bilateral involvement. Mean age was 30 years. All patients were motorcyclists. The mean preoperative intramuscular pressure at 1 min after effort was 60.75 mmHg (range: 30-81 mmHg). The main study endpoint was change in pain on visual analogic scale. Secondary endpoints comprised patient satisfaction, change in competitive sports level, and time to return to sport. Complications were noted. RESULTS Six patients (12 forearms) were evaluated. Mean follow-up was 22.5 months (range: 3-48 months). Mean pain rating was 7.3/10 (range: 6-9) preoperatively, and 0/10 postoperatively. All patients were satisfied with the procedure. Mean time to return to sports was 25.5 days (range: 21-30 days). No patients decreased their competitive sports level after the procedure. One patient presented a postoperative hematoma, not requiring surgery. CONCLUSION Ultrasound-guided fasciotomy in the treatment of Forearm chronic exertional compartment syndrome is an innovative technique with promising preliminary results. LEVEL OF EVIDENCE IV; retrospective cohort.
Collapse
Affiliation(s)
- Jean-Baptiste Facon
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France.
| | - Nicolas Mainard
- Lille University Center, Jeanne de Flandre Hospital, Department of Pediatric Orthopedics, Avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Pascal Louis
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France
| | | | - Jean-Michel Cognet
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France
| |
Collapse
|
2
|
Scheibler AG, Schweizer A. Isolated Chronic Exertional Compartment Syndrome of the Flexor Carpi Radialis: A Case Report. Orthop J Sports Med 2021; 9:23259671211035455. [PMID: 34734093 PMCID: PMC8558610 DOI: 10.1177/23259671211035455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/13/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Anne-Gita Scheibler
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| | - Andreas Schweizer
- Department of Orthopedics, Balgrist University Hospital, Zurich, Switzerland
| |
Collapse
|
3
|
Chronic Exertional Compartment Syndrome of the Forearm: Mini-invasive Technique Using an Endoscopic Soft Tissue Release System. Tech Hand Up Extrem Surg 2020; 25:127-128. [PMID: 33231948 DOI: 10.1097/bth.0000000000000315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic exertional compartment syndrome of the forearm is a rare disease characterized by the recurrent onset of forearm pain and progressive weakness during exertion. Over the years many surgical techniques have been reported in literature: wide-open fasciotomy, mini-open fasciotomy, fasciotomy associated with fasciectomy, and mini-invasive endoscopic fasciotomy. Compared with traditional open techniques, mini-invasive techniques are characterized by minimal tissue trauma, less postoperative pain, faster recovery to normal activity and better esthetical result. We describe a mini-invasive endoscopic technique for the treatment of forearm chronic exertional compartment syndrome using the SmartRelease endoscopic tissue release system (MicroAire).
Collapse
|
4
|
Ding A, Machin M, Onida S, Davies AH. A systematic review of fasciotomy in chronic exertional compartment syndrome. J Vasc Surg 2020; 72:1802-1812. [DOI: 10.1016/j.jvs.2020.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/14/2020] [Indexed: 11/25/2022]
|
5
|
Ruyer J, Rutka V, Garret J, Rizzo C, Guigal V. 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 & REHABILITATION 2020; 39:154-158. [PMID: 32126290 DOI: 10.1016/j.hansur.2020.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 12/31/2019] [Accepted: 01/23/2020] [Indexed: 12/22/2022]
Abstract
Exertional compartment syndrome of the forearm is a rare pathology, occurring almost exclusively in motorcycle racers. The results of endoscopic techniques are similar to those of open fasciotomies, but they are less invasive and leave smaller scars. The aim of our study was to present a new endoscopic technique for superficial fasciotomy using the Agee® system and to describe the results. This was a single-center, retrospective descriptive study of 21 patients (36 forearms) operated on between 2006 and 2016. All patients but one were competitive motorcycle racers. The mean operating time was 38.2min (standard deviation (SD), 10.5min). The QuickDASH score was 23.3±10.2% preoperatively versus 1±2% postoperatively (mean±SD). Among the 18 patients who came back for a follow-up visit after 4.9±2.7 years, 17 (94%) were satisfied or very satisfied. The mean time before returning to sport was 4.3 weeks (SD, 1.8 weeks), 9 patients (50%) at the same level as before surgery, 8 (44%) at a higher level, and one at a lower level. There were a few minor complications (superficial vascular lesions, hematoma, transitory hypoesthesia) and symptoms recurred in two patients. Our technique yields outcomes similar to those of other published endoscopic procedures and allows early return to sport. It has the advantage of being based on the Agee endoscope, which is commonly used to treat carpal tunnel syndrome, making the procedure easy to master.
Collapse
Affiliation(s)
- J Ruyer
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - V Rutka
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - J Garret
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - C Rizzo
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France
| | - V Guigal
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France.
| |
Collapse
|
6
|
Abstract
Chronic exertional compartment syndrome (CECS) is an overuse injury characterized by increased intracompartmental pressure during exercise. CECS has been described in the foot, thigh, and trunk, but 95% of cases occur in the lower leg. Interestingly, CECS may also affect the upper extremities and has been best described in the forearms. Unfortunately, due to the rarity of this condition, there is no consensus regarding its diagnosis and treatment. This review seeks to discuss the prevalence, etiology, diagnosis, and treatment of CECS of the forearms, which has been described in the literature.
Collapse
Affiliation(s)
- Kunal Sindhu
- a Department of Radiation Oncology , Mount Sinai Hospital, Icahn School of Medicine , New York , NY , USA
| | - Brian Cohen
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Joseph A Gil
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Travis Blood
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| | - Brett D Owens
- b Department of Orthopaedic Surgery, Warren Alpert School of Medicine , Brown University , Providence , RI , USA
| |
Collapse
|
7
|
Pegoli L, Pozzi A, Pivato G. Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long Term Follow-up. J Hand Surg Asian Pac Vol 2018; 21:8-12. [PMID: 27454495 DOI: 10.1142/s2424835516400026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic exertional compartment syndrome of the forearm is an uncommon condition, occurring in some populations such as athletes. The standard surgical treatment for professional athletes who cannot avoid trigger activity is an open forearm fasciotomy, which may require a long recovery time. The aim of this study is to present a new endoscopic single approach forearm fasciotomy technique and outcomes of at least 3 years follow up. METHODS We performed the endoscopic single approach forearm fasciotomy in 4 forearms in 3 men with the mean age of 25 years. All of the patients were evaluated at a mean follow up of 46 months using the Visual Analog Scale (VAS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS DASH improved from 21.71 to 5.39, VAS score improved too All the patients referred pain absence after the stress test performed at 20 kilos and 40 kilos. In our series no post-operative complications were observed. CONCLUSIONS The new mini-invasive technique has proved to be safe, reliable in a long-term follow-up. The main advantage is the shortening of the recovering time, that leads to a faster return to the professional activity.
Collapse
Affiliation(s)
- L Pegoli
- 1 Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
| | - A Pozzi
- 1 Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
| | - G Pivato
- 1 Hand and Reconstructive Microsurgery Unit, S. Pio X Clinic, Milan, Italy
| |
Collapse
|
8
|
Vajapey S, Miller TL. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. PHYSICIAN SPORTSMED 2017; 45:391-398. [PMID: 28952402 DOI: 10.1080/00913847.2017.1384289] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chronic exertional compartment syndrome (CECS) is a rare condition that usually affects distance runners and other running athletes. It is characterized by pain and pressure in one or multiple muscle compartments with repetitive physical activity. Reduction in pain typically occurs with cessation of activity. Evaluation of CECS consists of a thorough history of patient symptoms and ruling out of other causes of symptoms. Post-exercise pressure measurements can help confirm the diagnosis when symptoms are consistent and imaging evaluation negative for other causes. Non-operative treatment is a viable option for hindfoot runners and patients with anterior compartment syndrome of the leg. Limited-incision fasciotomy has been shown to be the most effective treatment and remains the gold standard for treatment. Minimal-incision open fasciotomy and endoscopic fasciotomy have surgical outcomes similar to wide-open fasciotomy. Military patients treated with fasciotomy have higher failure rates compared to civilians. Pediatric patients have similar outcomes compared to adults.
Collapse
Affiliation(s)
- Sravya Vajapey
- a Wexner Medical Center, Orthopaedics , Ohio State University , Columbus , OH , USA
| | - Timothy L Miller
- a Wexner Medical Center, Orthopaedics , Ohio State University , Columbus , OH , USA
| |
Collapse
|
9
|
Winkes MB, Teijink JA, Scheltinga MR. Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome. BMJ Case Rep 2016; 2016:10.1136/bcr-2016-214739. [PMID: 27080851 DOI: 10.1136/bcr-2016-214739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
We discuss a case of a 26-year-old man, a motorcycle racer, who presented with progressive pain, weakness and swelling of his right forearm and loss of power in his index finger, experienced during motor racing. Chronic exertional compartment syndrome (CECS) of both flexor and extensor compartments of his forearm was diagnosed by dynamic intracompartmental muscle pressure measurements. After fasciotomies, all symptoms were resolved and the patient was able to improve on his preinjury racing skills, without any limitations. A literature review and a surgical 'how-to' for correct release of the extensor and deep flexor compartments of the forearm are provided.
Collapse
Affiliation(s)
- Michiel B Winkes
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| | - Joep A Teijink
- Department of General Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - Marc R Scheltinga
- Department of General Surgery, Máxima Medical Center, Veldhoven, The Netherlands
| |
Collapse
|