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 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