Compartment Syndrome of forearm

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work!

Definition/Description

Compartment Syndrome of the forearm is a condition in which pressure inside the closed osseofascial compartment increases to such an extent that there is a compromise of microcirculation, leading to tissue damage[1]. It may or may not be preceded by fracture or traumatic injury. Although uncommon, compartment syndrome of the forearm is a well recognized diagnosis that can lead to significant morbidity and mortality if not diagnosed and treated early in the clinical course[2].

Etiology

Traumatic
  • Fractures of the forearm - including both diaphyseal forearm fractures and fractures of the distal radius[3] (most common)
  • Crush injuries
  • Penetrating trauma
Non-traumatic[4]
  • Reperfusion injury
  • Angioplasty or angiography
  • Intravenous line extravasations
  • Injection of illicit drugs
  • Coagulopathies or bleeding disorders
  • Hematoma in patients treated with anticoagulants
  • Constrictive dressings or casts
  • Burns
  • Insect bites

Relevant Anatomy

There are four compartments of the forearm: dorsal, superficial volar, deep volar, and the mobile wad.

Cross-section middle of the forearm.gif

Clinical Presentation

Patients typically present with swelling of the forearm and complains of pain and difficulty with hand and wrist motion, particularly with passive motion. It may also beaccompanied with paresthesias of the hand depending on the clinical course. Compartment syndrome hallmarks have been the 5 Ps: pain out of proportion, pallor, paresthesias, paralysis, and pulselessness. Pain out of proportion and pain with passive stretching of the fingers are considered the first and most sensitive signs of compartment syndrome in an awake patient.

Diagonistic Procedures

Differential Diagnosis

Medical Management

  • Adequate decompression of the forearm requires fascial release of both the dorsal and volar compartments, with the volar compartment best released from the carpal tunnel distally to across the lacertus fibrosus proximally.
  • Fasciotomy wounds must be assessed every 48 hours to 72 hours and additional soft tissue coverage procedures for wound closure are common.

Physical Therapy Management

Prognosis

Helpful Resources

References

  1. Raza H, Mahapatra A. Acute compartment syndrome in orthopedics: causes, diagnosis, and management. Advances in orthopedics. 2015;2015.
  2. Kistler, J.M., Ilyas, A.M. and Thoder, J.J., 2018. Forearm compartment syndrome: evaluation and management. Hand clinics34(1), pp.53-60.
  3. Prasarn ML, Ouellette EA. Acute compartment syndrome of the upper extremity. JAAOS-Journal of the American Academy of Orthopaedic Surgeons. 2011 Jan 1;19(1):49-58.
  4. Donaldson J, Haddad B, Khan WS. Suppl 1: the pathophysiology, diagnosis and current management of acute compartment syndrome. The open orthopaedics journal. 2014;8:185.