Anatomy
The forearm muscles are divided into 3 groups (compartments) of strong muscle membranes (fasciae) that are partially inextensible. An anterior muscle group i.e. the dorsal side of the forearm (volar compartment containing the extensor muscles), an external muscle group (radial/lateral compartment) and a posterior muscle group i.e. the palm side of the forearm (dorsal compartment containing the flexor muscles). Each muscle group has its own blood and nerve supply.
Cause
During muscle training, muscles can grow so fast that the surrounding muscle membranes (fascia) cannot give way sufficiently. This increases the pressure in the muscle tissue, which can affect the muscles, blood vessels and nerves (chronic compartment syndrome).
In the event of acute severe strain or direct trauma (e.g. fractures of the forearm bones), fluid accumulation and haemorrhaging in the muscle joint can occur, causing significantly increased pressure in the muscle joint with acute effects on muscles, nerves and blood vessels (acute compartment syndrome).
Symptoms
In chronic compartment syndrome in the arm (which is mainly seen in sports with prolonged, heavy muscle strain at elite level, such as rowing), there is a slow onset of pain in the muscles. You can feel the muscle ‘tighten’ and become hard, which is accompanied by discomfort. The pain subsides a few minutes after stopping the strain, but quickly returns if the strain is resumed. Not infrequently, there are sensory disturbances in the fingers.
Acute compartment syndrome is characterised by increasing pain that is often more severe than expected based on the primary assessment of the extent of the injury. Even stretching hurts. There may also be numbness in the fingers and the discomfort does not subside shortly after stopping exertion.
Examination
Acute compartment syndrome is characterised by increasing pain that is often more severe than expected based on the primary assessment of the extent of the injury. Even stretching hurts. There may also be numbness in the fingers and the discomfort does not subside shortly after stopping exertion.
If acute compartment syndrome is suspected, an urgent medical examination must be performed (possibly in hospital).
Treatment
The treatment for chronic compartment syndrome is relief from pain-inducing activity, stretching and slowly increasing strength training within the pain threshold to allow the muscle barriers to give way. If there is persistent discomfort or frequent relapses despite regular rehabilitation, one or more of the muscle splints can be divided (Smeraglia F, et al. 2021).
Acute compartment syndrome always requires urgent medical examination (possibly in a hospital) with the possibility of emergency surgical splitting of the muscle membranes, otherwise permanent damage to muscles and nerves may occur.
Complications
Acute compartment syndrome can cause permanent damage to muscles and nerves if not treated as soon as possible. Amputations have been described after acute compartment syndromes.
Especially
As there is a risk that acute compartment syndromes can cause permanent damage, the injury should be reported to your insurance company.
If surgery has been performed for both acute and chronic compartment syndrome, there may be specific rehabilitation instructions from the surgeon depending on the type and course of surgery.As there is a risk that acute compartment syndromes can cause permanent damage, the injury should be reported to your insurance company.
