Diagnosis of chronic exertional compartment syndrome in primary care

Chatterjee, Robin

doi:10.3399/bjgp15x686329

Cited by 8 publications

(9 citation statements)

References 9 publications

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“…Instead, the important factor for CECS seems to be the rise in pressure from resting to 5 min after exercise, perhaps as a percent, and delayed normalization. All reports in literature support that as a consistent phenomenon [1, 2, 12, 17, 20]. Perhaps these two elements should be investigated more thoroughly in future studies.…”

Section: Discussionmentioning

confidence: 69%

“…Because MRIs and clinical presentation are non-invasive techniques, we believe that the addition of compartment pressure evaluation is obligatory before a definitive diagnosis is made and a fasciotomy pursued. Although there has been evidence of variance in normal compartment values, any significant rise in pressure post-exercise is highly indicative of CECS [ 2 , 3 , 6 , 12 , 15 , 17 , 19 ]. In fact, many other studies have concluded that the best method for diagnosing CECS is evaluation of intracompartmental pressures (ICPs) before and after exercise [ 2 , 5 , 12 , 15 , 17 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although there has been evidence of variance in normal compartment values, any significant rise in pressure post-exercise is highly indicative of CECS [ 2 , 3 , 6 , 12 , 15 , 17 , 19 ]. In fact, many other studies have concluded that the best method for diagnosing CECS is evaluation of intracompartmental pressures (ICPs) before and after exercise [ 2 , 5 , 12 , 15 , 17 , 20 ]. However, in agreement with Rorabeck et al, we believe ICPs are only a supplemental component to the history and physical examination.…”

Section: Discussionmentioning

confidence: 99%

“…CECS is often overlooked as the cause of muscle pain and paresthesia in the extremities, due to its rarity and diverse manifestation. CECS may present with many different symptoms, appear identical to other etiologies, lack physical exam findings, and appear intermittently as well as transiently [ 2 , 3 ]. Diagnosis can be delayed as long as 22 months in some instances [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Chronic Exertional Compartment Syndrome in the Forearm of a Collegiate Softball Pitcher

et al. 2017

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BackgroundChronic exertional compartment syndrome (CECS) is a recognized condition in the lower limb, with many reports in the literature. However, very few instances include CECS of the upper limb. This article presents the case of a collegiate softball pitcher presenting with CECS in her right forearm. To our knowledge, this is the first case report of a softball player with CECS, with only one similar incident in a major league baseball player.PurposeThe rarity of this condition normally places it low on the differential diagnosis. However, we hope that the presentation of this case and the review of the literature will aid in making swift and accurate diagnoses of CECS in future patients. We discuss the importance of three specific modalities in the diagnosis of this patient, what diagnostic criteria proved less conclusive, and the paradoxical course the syndrome presented with.Study DesignCase ReviewResultsOver a six-month period, the patient presented with peculiar presentations and exam results. A broad list of differential diagnoses had to be narrowed down through the presence or absence of relevant findings. These included cessation of exercise for 1 month, physical therapy, anti-inflammatory medicines, an electromyography/electromyogram (EMG), nerve conduction study (NCS), non-exercise magnetic resonance imaging (MRI) of the forearm, cervical MRI, and cervical computed tomography (CT) angiogram. After the above interventions were attempted and the relative findings of three important modalities were summarized, a fasciotomy and release of the dorsal, volar, and mobile wad compartments was performed. The patient’s symptoms were relieved, and she eventually returned to full play in softball at the university.ConclusionsThe three diagnostic criteria we believed to be most helpful in this case, and for future cases of CECS in the forearm, include the clinical presentation, pre- and post-exercise MRI, and pre- and post-exercise compartment pressure measurements.Clinical RelevanceChronic exertional compartment syndrome of the forearm is extremely rare, especially in the female athlete. This case report and review of the literature may be helpful to the clinician facing similar cases. It describes which clinical tests are most helpful for diagnosis and which findings may be distracting.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Chronic Exertional Compartment Syndrome in the Forearm of a Collegiate Softball Pitcher

et al. 2017

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“…The symptoms are often bilateral and are brought on by exertion and relieved by rest, recurring when the precipitating activity is resumed [ 1 ]. When a patient with an episode of CECS presents with these and other wide ranging symptoms, they can be—as in our patient—a red herring that distracts healthcare providers from determining the diagnosis in a timely fashion [ 6 , 41 ]. Adding to the conclusion, the patients are also often asymptomatic at rest, showing minimal findings upon examination.…”

Section: Discussionmentioning

confidence: 99%

Upper Extremity Compartment Syndrome in a Patient with Acute Gout Attack but without Trauma or Other Typical Causes

Skedros

Smith

Henrie

et al. 2018

Case Reports in Orthopedics

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We report the case of a 30-year-old Polynesian male with a severe gout flare of multiple joints and simultaneous acute compartment syndrome (ACS) of his right forearm and hand without trauma or other typical causes. He had a long history of gout flares, but none were known to be associated with compartment syndrome. He also had concurrent infections in his right elbow joint and olecranon bursa. A few days prior to this episode of ACS, high pain and swelling occurred in his right upper extremity after a minimal workout with light weights. A similar episode occurred seven months prior and was attributed to a gout flare. Unlike past flares that resolved with colchicine and/or anti-inflammatory medications, his current upper extremity pain/swelling worsened and became severe. Hand and forearm fasciotomies were performed. Workup included general medicine, rheumatology and infectious disease consultations, myriad blood tests, and imaging studies including Doppler ultrasound and CT angiography. Additional clinical history suggested that he had previously unrecognized recurrent exertional compartment syndrome that led to the episode of ACS reported here. Chronic exertional compartment syndrome (CECS) presents a difficult diagnosis when presented with multiple symptoms concurrently. This case provides an example of one such diagnosis.

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