Surgical Decompression of Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Racers

Haddad, Sleiman; Correa-Vázquez, Eva; Segura, Jordi Font; Gil, Emilia; Lluch, Àlex; Soldado, Francisco; Mir-Bulló, Xavier

doi:10.1097/jsm.0000000000000216

Cited by 32 publications

(20 citation statements)

References 24 publications

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“…The optimal surgical approach is debated. Some favour a wide open or a minimally open operation, whereas others promote an endoscopic release, all having similar beneficial results 2 3 30. Complication rates are frequently not reported.…”

Section: Discussionmentioning

confidence: 99%

Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome

2016

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We discuss a case of a 26-year-old man, a motorcycle racer, who presented with progressive pain, weakness and swelling of his right forearm and loss of power in his index finger, experienced during motor racing. Chronic exertional compartment syndrome (CECS) of both flexor and extensor compartments of his forearm was diagnosed by dynamic intracompartmental muscle pressure measurements. After fasciotomies, all symptoms were resolved and the patient was able to improve on his preinjury racing skills, without any limitations. A literature review and a surgical 'how-to' for correct release of the extensor and deep flexor compartments of the forearm are provided.

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Section: Discussionmentioning

confidence: 99%

Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome

2016

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“…Given the rarity of CECS in the forearm, there have been few studies on the outcomes of fasciotomy of the upper extremity. As previously stated, forearm CECS has been described in rowers11 and motorcyclists 5,12,13. For patients that fail nonoperative therapy (eg, massage, stretching, splinting, activity modification), fasciotomy is recommended, as it generally offers excellent results 3,5.…”

Section: Treatment and Outcomes For Upper-extremity Cecsmentioning

confidence: 99%

“…The authors highlighted that recovery time and smaller scars were advantages of this approach. Barrerra-Ochoa et al12 did a comparative study on the long-term results of wide-open versus mini-open fasciotomy after 45.35±12 months of follow-up. They found no significant difference between the surgical groups.…”

Section: Treatment and Outcomes For Upper-extremity Cecsmentioning

confidence: 99%

“…Lower-extremity CECS is most often observed in running athletes7 and marching military members 8–10. Upper-extremity CECS is most commonly seen in rowers11 and professional motorcyclists 5,12,13. Although early outcome research on CECS was based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females 5,14–16…”

Section: Introductionmentioning

confidence: 99%

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<p>Chronic exertional compartment syndrome: current management strategies</p>

Buerba¹,

Fretes²,

Devana³

et al. 2019

OAJSM

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Chronic exertional compartment syndrome (CECS) is an underdiagnosed condition that causes lower and upper extremity pain in certain at-risk populations. Lower-extremity CECS is most often observed in running athletes and marching military members. Upper-extremity CECS is most commonly seen in rowers and professional motorcyclists. Although early outcome research on CECS has been based mostly on adult male patients, there has been an increase in the number of studies in pediatric and adolescent patient populations, particularly in females. Evaluation of CECS must include a thorough history and physical exam to rule out other causes of exertional leg pain, but differential diagnosis must remain high on the list. Needle manometry can be used to confirm diagnosis of CECS by measuring intracompartmental pressure. Operative treatment of CECS with fasciotomy has been shown to be effective in resolution of CECS, and new surgical techniques are being developed. In the pediatric population, endoscopy-assisted compartment release has provided high success rates with low complication rates. Nonoperative management of CECS is more commonly described in the literature, and consists of cessation of activities, altering foot-strike pattern, physical therapy, taping, and injections of botulinum toxin A. Nonetheless, larger samples and a more diverse population are needed to better understand the outcomes of nonoperative management. There have been fewer studies on upper-extremity CECS, given its rarity. Success has been found in the treatment of upper-extremity CECS with open fasciotomy, but more studies are needed to understand the efficacy of minimally invasive techniques in the upper extremity. Further research also needs to be done to understand why a large portion (approximately 20%) of the patient population does not experience full resolution of symptoms after fasciotomy.

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“…Conventionally, treatment of compartment syndrome is open surgical fasciotomy, which is associated with complications of open surgery, including pain, scarring, adhesions, and infection [2]. To reduce complications, less-invasive approaches have been developed aiming to maintain efficacy and reduce postoperative pain, improve patient satisfaction, and reduce recovery time vs. open surgery [3, 4]. These include using Metzenbaum or endoscopic scissors via small skin incisions [5, 6] and ultrasound-guided meniscotome instruments [7].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound-guided percutaneous compartment release: a novel technique, proof of concept, and clinical relevance

2018

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Objective Ultrasound-guided thread release (USGTR) is a minimally invasive technique with excellent clinical outcomes currently used in clinical practice to divide the transverse carpal ligament in carpal tunnel syndrome. The purpose of this study is to determine whether this technique can be modified for use in large anatomical compartments in soft embalmed cadaveric models. Materials and methods Two operators adapted the USGTR technique for use in muscular compartments of the forearms and legs in a single soft embalmed cadaver. An iterative approach was used to adapt and improve the technique for use in large compartments, using equipment readily available in most radiology departments. Results The USGTR technique was successfully modified and both operators were able to accurately divide fascial layers over distances of up to 30 cm using the modified technique. Fascial division was confirmed with ultrasound and dissection. Conclusions This adapted technique can successfully be used to divide fascial planes over longer distances than is currently achieved in clinical practice. The improved outcomes associated with USGTR at the carpal tunnel may therefore also be achievable in fasciotomy procedures in larger anatomical compartments. Further study is required to investigate the effects of this modified USGTR technique on intracompartmental pressure.

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Surgical Decompression of Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Racers

Abstract: Surgical open or mini-invasive fasciotomy is equally successful in motorcycling racers with forearm CECS.

Cited by 32 publications

References 24 publications

Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome

Motorcycle racer with unilateral forearm flexor and extensor chronic exertional compartment syndrome

<p>Chronic exertional compartment syndrome: current management strategies</p>

Ultrasound-guided percutaneous compartment release: a novel technique, proof of concept, and clinical relevance

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