Chronic exertional compartment syndrome in the forearm: Ultrasound-guided surgical technique.

Abstract

Introduction: Chronic exertional compartment syndrome of the forearm is most commonly associated with exercise. It presents as cramping after a few minutes of activity, requiring cessation of exercise. We describe an ultrasound-guided surgical technique for the treatment of forearm chronic exertional compartment syndrome.

Anatomy and pathophysiology: The forearm consists of three compartments: the anterior, lateral, and dorsal compartments. These compartments are formed by the muscles of the forearm and are surrounded by a fibroelastic membrane composed of connective tissue. Repetitive activity in the forearm leads to an increase in muscle volume within a non-extensible compartment. This increase in pressure causes pain and cramping, forcing the individual to stop the activity. Diagnosis is based on measurement of intramuscular compartment pressures.

Surgical technique: Surgical treatment involves performing a fasciotomy. This can be done through an incision along the length of the forearm or through a minimally invasive approach using endoscopic or ultrasound guidance. The ultrasound-guided technique uses two small entry points and a specialized knife. No post-operative immobilization is required, allowing patients to quickly resume their activities.

Discussion: Chronic exertional compartment syndrome of the forearm is a condition that is particularly common among motorcyclists. Diagnosis is based on a combination of a suggestive clinical presentation and pathological intramuscular pressure. Treatment may be conservative or surgical (fasciotomy). Fasciotomy can be performed using an open approach or a minimally invasive ultrasound-guided technique. Published studies on ultrasound-guided treatment report excellent results with a rapid return to sports activities after surgery.