Revista de Medicina Desportiva (English) March 2018 | Page 28

SPAT
Sociedade Portuguesa de
Artroscopia e Traumatologia
Desportiva
Revista Medicina Desportiva informa, 2018; 9(2):26-29.
Chronic exertional
compartment syndrome of
forearm – Arm Pump
Dra. Ana Luísa Neto 1 , Dr. G. Morais Sarmento 2
1
Orthopaedic resident; 2 Othopaedic senior. Hospital Ortopédico de Sant’Ana – Parede
ABSTRACT
Forearm chronic exertional compartment syndrome, arm pump in motorcycling sports, is a rare
condition characterized by recurrent and exercise-induced episodes of pain and functional loss of the
limb. The typical clinical history makes the diagnosis that is an exclusion one, although intracom-
partmental pressure measurement is of clinical and scientific value in this condition. Chronic exer-
tional compartment syndrome has been particularly connected to high performance sports practice,
which itself conditions the treatment in this particular group of patients. Palmar forearm fasciotomy
is the gold standard treatment and it has good short term results.
KEYWORDS
Compartmental syndrome, forearm, arm-pump, fasciotomy
Introduction
Chronic Exertional Compartment
Syndrome (CECS) is a disease
defined by recurring episodes of
pain, numbness or dysesthesia, and
limb disability. 1-3 It occurs following
an intense and longstanding effort,
and it relieves with rest. 1-3 The clini-
cal presentation of the disease was
firstly described in 1912, by Edward
Wilson, although pathophysiological
mechanism was just studied later. 4-6
Unlike acute compartment syn-
drome, CECS is a fairly unknown
pathology, often misdiagnosed,
whereby real incidence remains
uncertain. 6,7,8 Most of clinical
cases described in literature con-
cern to leg compartments’ SCCE,
mainly in racing sports athletes. 9,10
However, this syndrome may also
presents in forearm, thigh, foot
26 march 2018 www.revdesportiva.pt
and sacrum-ileum-lumbar mus-
cles. 9 First case of forearm SCCE
was reported by Joseph E. Kutz in
1985. 11 Until last decade, less than
twenty cases of forearm CECS had
been reported. 12 Nevertheless, there
have been published wide casuistics
recently, such as the Christophe
Jans 13 and Sergi Barrera-Ochoa 14
series. The purpose of this study was
to review the current literature of
forearm chronic exertional compart-
ment syndrome.
Etiology
Forearm CECS seems to be a result
of longstanding wrist and fingers
isometric contraction, with a flexion
elbow. 1,12 It has been described
mainly as a motorcycle racing
disease, where it takes Arm Pump
designation. 8,15 Other professional
or leisure activities, which depends
of intense and extended efforts of
the upper limbs may also trigger
this syndrome. As examples there
are gymnastics, hockey, wheelchair
sports, water skiing, cycling, tennis,
rowing, kayaking, as well as wight
lifters, violinists, pianists, soldiers
and other manual workers. 1,3,13,16-18
It was also found in literature
sporadic reports of forearm CECS
related to baseball and softball
practice. 17,19 It is also known that it
rather appears in athletes who favor
muscular strengthening, indepen-
dently or as gym work, mainly of
wrist and hand flexores groups, thus
leading to the huge muscular hyper-
trophy at rest. The reason why only
a small percentage of individuals
develops the symptoms, is not yet
known. So, genetic factors have been
considered involved in the whole
process. 18
Pathophysiology
Pathophysiological mechanisms
underlying CECS remain unclear.
Several studies have suggested that
muscular hypertrophy, as a result of
exertion, may lead to an increase in
muscle volume up to 20% during the
effort, returning to normal at rest. 1,8
Beside that, a firm muscular fascia,
lacking elasticity, and often thick-
ened, prevents the ability to accom-
modate the volume increase. 2,5,13
All this factors, lead to an increase
in intra-compartmental pressure,
with consequent microvascular
failure and a decrease of venous