Compartment Syndrome of the Forearm

Abstract

Compartment syndrome is a group of symptoms associated with elevated interstitial tissue pressure within a limited space of fascial compartments. The forearm is divided into two main compartments, the dorsal and the volar compartments. Further, the dorsal compartment can be subdivided into the extensor compartment and the mobile wad compartment, and the volar compartment into the superficial and the deep components. Unlike the fascial compartments of the leg, the forearm compartments are interconnected. These interconnections are of importance in that a release of the volar compartment alone may sufficiently decompress the dorsal compartment.

Fortunately, compartment syndrome is a rare complication after distal radius fractures and occurs in less than 1 % of the cases. The diagnosis of compartment syndrome is primarily a clinical one, based on symptoms of muscle and nerve ischemia. Persistent, increasing pain, usually out of proportion to that expected from the injury, is the most important finding. A tense, swollen and tender compartment is present. The most typical sign is increasing pain with passive stretch of the muscles within the compartrment: Thus move the patients wrist and fingers!!.

Sensory disturbances in the nerve distribution are intermediate findings. Motor paralysis and pulselessness are late findings. The diagnosis may be verified by intra-compartmental pressure measurements. If this pressure is above 30–45 mmHg and concomitant clinical findings are present, fasciotomy should be performed. Start the incision distally like in an ordinary carpal tunnel decompression procedure. Release the skin, volar fascia and transverse carpal ligament. Continue the incision proximally and over the most prominent forearm muscles, forming a lazy-S, up to the antecubital fossa.