Objective: To describe the evaluation, diagnosis, and current treatment of a men’s soccer player with compartment syndrome of the forearm.
Background: The forearm is the most common site for compartment syndrome in the upper extremity. The compartments of the forearm include the volar (anterior or flexor), and the dorsal (posterior or exterior). Both bone forearm fractures and distal radius fractures are common initial injuries that lead to acute forearm compartment syndrome. The flexor digitorum profundus and flexor pollicis longus are among the most severely affected muscles because of their deep location, closest to the bone.
Differential Diagnosis: Other possible injuries and conditions which need to be ruled out include stress fractures and fractures of the radius and ulna.
Treatment: The treatment goal, as with most athletic injuries, is to restore the athlete’s injury, pain free, with functional abilities similar to that prior to the injury. We aimed to restore circulation to the compartment through decompression. The main treatment the athlete endured was ultrasound modality, allowing the tissue to heal.
Uniqueness: Acute compartment syndrome in most common in the legs. The incidence of compartment syndrome is greatest where there are smaller compartments enveloped in tight sheath, which include the forearm and the lower leg.
Conclusion: The prognosis depends on the intensity and duration of the compartment pressure. Acute compartment syndrome results from fluid pressure in a closed compartment. If left untreated, it can lead to more severe conditions including rhabdonyolysis and kidney failure, potentially leading to death.
Personal data/ Signs and Symptoms
The athlete is a 20-year-old male soccer player for Kansas Wesleyan University. He is 5 foot 11 inches tall and weighs 175 pounds. The athlete was slide tackling for a ball when an opposing player landed on his forearm, hyper extending his elbow. He complained of immediate numbness and tingling throughout the lower arm. He has immediate decrease grip strength, but sensation was fine throughout the lower arm, elbow and upper arm. Our initial assessment was hyper extension of the elbow, stretching of the medial nerve, and compression of the ulnar nerve. We made the athlete see the doctor to rule out other possible injuries. Assessment and Diagnosis
The athlete was seen by Dr. Harbin the day after the injury occurred. There was no apparent deformity or discoloration at this time. He had moderate inflammation in his left elbow and forearm. His range of motion is decreased, along with his flexion and extension. He is most comfortable with his elbow in about 10 degrees of flexion. He can feel sensation with touch and temperature change, but is feeling some numbness and tingling of his forearm. He was experiencing pain and inflammation along volar extensor aspect of the forearm and pronator. At this point, it was evident that his hand had inflammation. He has posterior hematoma as well. The athlete had both decreased flexion, and extension of the forearm. His flexion and extension of the wrist were within the normal limits, but seemed to be quite a bit slower than normal. When going through the series of tests, they were all negative. The only positive test was Tinel’s sign. I performed both, valgus and varus stress tests at both 0 degrees, and 30 degrees. They were negative as well. The athlete was then diagnosed as having compartment syndrome for the forearm. We will work on his range of motion, three days a week. The athlete must be functionally tested before we can release him to play. Will test him in one week. Differential diagnosis
Compartment syndrome occurs when excessive pressure builds up inside an enclosed space in the body. It usually results from bleeding or swelling after an injury. The dangerously high...