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218: COMPARTMENT SYNDROME, FOREARM

Stacey L. Frazee, DPT; Eric Shamus, PhD, DPT, PT, CSCS

CONDITION/DISORDER SYNONYMS

  • Chronic compartment syndrome (CCS)

  • Chronic exertional compartment syndrome (CECC)

  • Limb compartment syndrome

  • Myofascial compartment syndrome

  • Volar compartment syndrome of forearm (flexors)

  • Dorsal compartment syndrome of forearm (extensors)

ICD-9-CM CODES1

  • 729.71 Nontraumatic compartment syndrome of upper extremity

  • 958.91 Traumatic compartment syndrome of upper extremity

ICD-10-CM CODES2

  • M62.2 Ischemic infarction of muscle (nontraumatic compartment syndrome)

  • M79.A1 Nontraumatic compartment syndrome of upper extremity

  • T79.6 Traumatic ischemia of muscle

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired joint mobility, motor function, muscle performance, and range of motion associated with localized inflammation

PATIENT PRESENTATION

A 31-year-old man with a recent forearm crush injury presents with severe unilateral forearm pain that has intensified since his injury. He indicates that his injury was sustained 3 weeks ago. He is currently experiencing tightness in the medial forearm and tingling in the thumb, index and middle fingers. Distal pulses and capillary refill are diminished. He is having weakness throughout the wrist/forearm. There is increased pain with squeezing of the forearm musculature. The patient was referred to the emergency room and his physician was notified.

KEY FEATURES

Description

  • Bleeding or edema leads to increased pressure within the fascial compartment and compromises circulation within that space as well as the function of tissues in that area causing ischemia

  • Arteriolar compression occurs and causes muscle and nerve ischemia

    • Acute, sensory changes develop after 30 minutes of ischemia

    • Acute, irreversible nerve damage in 12 to 24 hours

    • Acute, irreversible muscle changes (i.e., necrosis) in 3 to 8 hours

FIGURE 218-1

Stryker STIC device for measuring compartment pressure. (Reprinted with permission from Reichman EF, Simon RR. Emergency Medicine Procedures. New York, NY: McGraw-Hill; 2004.)

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Essentials of Diagnosis

  • Diagnosis is typically made by clinical examination and compartment pressure measurement

  • Acute compartment syndrome

    • Medical emergency

    • Immediate surgery, fasciotomy

  • Subacute compartment syndrome

    • Less of an emergency, usually surgery, fasciotomy

  • Chronic exertional compartment syndrome

    • Conservative treatment first

    • Secondary surgery, fasciotomy

    • Symptoms consistently develop the same point during activity

    • Stops about 30 minutes following exercise

    • Symptoms can become progressively worse to constant

  • Severe pain that is not alleviated by elevation or pain medication

    • Pain increases with passive/active range of motion and compression

  • Distal pulses are diminished/absent

  • Strength and sensation are diminished

  • Edema in affected limb

General Considerations

  • Require emergency surgery to prevent permanent damage with pressure measurements of 30 mm Hg or higher

  • Forearm has two compartments

    • Volar

    • Dorsal

  • Classic P’s

    • Pain

    • Pallor

    • Pulselessness

    • Paresthesias

    • Paralysis

  • Complications

    • Infection

    • Contractures

    • Deformity

    • Amputation

    • Acidosis

    • Hyperkalemia

    • Myoglobinuria

    • Acute renal failure and shock

Demographics

  • Younger ...

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