Skip to main content

Advertisement

SpringerLink
Log in

Compartments of the antebrachial fascia of the forearm: clinically relevant ultrasound, anatomical and histological findings

  • Original Article
  • Published:
Surgical and Radiologic Anatomy Aims and scope Submit manuscript

Abstract

Purpose

Acute compartment syndrome is defined as a limb-threatening condition caused by bleeding or oedema in a closed muscle compartment surrounded by fascia or bone. It is most commonly encountered in the forearm, which has three compartments: posterior, anterior and lateral. These are surrounded and closed in by the antebrachial fascia, formed by dense connective tissue that facilities their study on ultrasound and is key to fasciotomy treatment. The purpose of this study was to broaden existing ultrasound, anatomical and histological knowledge of the fascia of the forearm to facilitate their identification on ultrasound, with possible clinical and therapeutic applications.

Methods

The study was performed in 50 cryopreserved upper limbs from adult cadavers from the dissection room of the Faculty of Medicine and Health Sciences. They were examined on ultrasound and subsequent anatomical dissection and microscopy to study the fascia and its relationship with different muscles of the forearm compartments.

Results

Distinct anatomical relationships were observed on ultrasound and dissection between the fascia and the extensor carpi ulnaris, extensor digiti minimi, and anconeus muscle in the posterior compartment, and the flexor carpi radialis and flexor carpi ulnaris in the anterior compartment. They were isolated by the antebrachial fascia and had distinct relationships with the neurovascular structures.

Conclusion

These results demonstrate that high-definition ultrasound enables us to locate the antebrachial fascia and particular muscles with a distinct relationship with neurovascular structures. This helps better identify these structures, facilitating diagnosis of any pathology in the area, with potential therapeutic and clinical applications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Abbreviations

ACS:

Acute compartment syndrome

A:

Anconeus muscle

BOA:

British Orthopaedic Association

ECU:

Extensor carpi ulnaris

EDM:

Extensor digiti minimi

ED:

Extensor digitorum

FCR:

Flexor carpi radialis

FCU:

Flexor carpi ulnaris

FDS:

Flexor digitorum superficialis

PL:

Palmaris longus

PT:

Pronator teres

References

  1. Benamran L, Masquelet AC (2018) A cadaver study into the number of fasciotomies required to decompress the anterior compartment in forearm compartment syndrome. SurgRadiolAnat 40(3):281–287. https://doi.org/10.1007/s00276-017-1947-3

    Article  Google Scholar 

  2. Benjamin M (2009) The fascia of the limbs and back—a review. J Anat 214(1):1–18. https://doi.org/10.1111/j.1469-7580.2008.01011.x

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bianchi S, Martinoli C, Derchi LE (2011) Ecografíamusculoesquelética. Marbán, Madrid. https://doi.org/10.1016/j.rh.2014.10.001

    Book  Google Scholar 

  4. Boabighi A, Kuhlmann JN, Luboinski J, Landjerit B (1993) Aponeuroses and superficial fascia. Mechanical and structural properties. Bulletin de l’Association des Anatomistes 77:3–7

    CAS  PubMed  Google Scholar 

  5. Bodansky D, Doorgakant A, Alsousou J et al (2018) Acute compartment syndrome: do guidelines for diagnosis and management make a difference? Injury 49:1699–1702. https://doi.org/10.1016/j.injury.2018.04.020

    Article  CAS  PubMed  Google Scholar 

  6. British Orthopaedic Association BAoPRaAS, Royal College of Nursing (2014) BOAST 10: Diagnosis and management of compartment syndrome of the limbs. Br Orthopaedic Assoc Stand Trauma. https://www.boa.ac.uk/publications/boa-standards-trauma-boasts.

  7. Degeorges R, Masquelet AC (2002) The cubital tunnel: anatomical study of its distal part. SurgRadiolAnat 24(3–4):169–176. https://doi.org/10.1007/s00276-002-0032-7

    Article  CAS  Google Scholar 

  8. Fontes D, Clement R, Roure P (2003) Endoscopic aponevrotomy for chronic exertionalcompartimental syndrome of the forearm: a series of 41 cases. Chir Main 22(4):186–196. https://doi.org/10.1016/s1297-3203(03)00060-x

    Article  CAS  PubMed  Google Scholar 

  9. Gaikwad MR, Ravi PK, Patnaik M (2019) A case of potentially lethal vascular variation in association with palmarisprofundus muscle. Anat Cell Biol 52(3):349–353. https://doi.org/10.5115/acb.19.061

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gourgiotis S, Villias C, Germanos S, Foukas A, Ridolfini MP (2007) Acute limb compartment syndrome: a review. J SurgEduc 64(3):178–186. https://doi.org/10.1016/j.jsurg.2007.03.006

    Article  Google Scholar 

  11. Guclu D, Arican M, Unlu EN (2018) Median nerve entrapment due to accessory palmarislongus muscle: MRI and sonography findings. BMJ Case Rep 2018:1–2. https://doi.org/10.1136/bcr-2018-224852

    Article  Google Scholar 

  12. Inserra S, Spinner M (1986) An anatomic factor significant in transposition of the ulnar nerve. J Hand Surg Am 11(1):80–82. https://doi.org/10.1016/s0363-5023(86)80109-5

    Article  CAS  PubMed  Google Scholar 

  13. Ipaktchi K, Wingfield J, Colakoglu S (2019) Fasciotomy: upper extremity. In: Ipaktchi K (ed) Compart syndrome: a guide to diagnosis and management, chapter 7. Springer, Cham, pp 59–66

    Chapter  Google Scholar 

  14. Lee KJ, Jin W, Kim GY et al (2015) Sonographic features of superficial-type nodular fasciitis in the musculoskeletal system. J Ultrasound Med 34(8):1465–1471. https://doi.org/10.7863/ultra.34.8.1465

    Article  PubMed  Google Scholar 

  15. Mackinnon SE, Novak CB (2007) Operative findings in reoperation of patients with cubital tunnel syndrome. Hand 2(3):137–143. https://doi.org/10.1007/s11552-007-9037-3

    Article  PubMed  PubMed Central  Google Scholar 

  16. McQueen MM, Gaston P, Court-Brown CM (2000) Acute compartment syndrome. who is at risk? J Bone JtSurg Br 82(2):200–203

    Article  CAS  Google Scholar 

  17. Meng S, Tinhofer I, Weninger WJ, Grisold W (2014) Anatomical and ultrasound correlation of the superficial branch of the radial nerve. Muscle Nerve 50(6):939–942. https://doi.org/10.1002/mus.24235

    Article  PubMed  Google Scholar 

  18. Ojike NI, Ala SR, Battista CT, Roberts CS (2012) A single volar incision fasciotomy will decompress all three forearm compartments: a cadaver study. Injury 43(11):1949–1952. https://doi.org/10.1016/j.injury.2012.08.006

    Article  PubMed  Google Scholar 

  19. Pirri C, Stecco C, Fede C, Macchi V, Özçakar L (2020) Ultrasound imaging of the fascial layers: you see (only) what you know. J Ultrasound Med 39(4):827–828. https://doi.org/10.1002/jum.15148

    Article  PubMed  Google Scholar 

  20. Ronel DN, Mtui E, Nolan WB (2004) 3rd Forearm compartment syndrome: anatomical analysis of surgical approaches to the deep space. Plastic ReconstrSurg 114(3):697–705. https://doi.org/10.1097/01.prs.0000130967.42426.23

    Article  Google Scholar 

  21. Ruyer J, Rutka V, Garret J, Rizzo C, Guigal V (2020) Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: clinical results of a new technique using an endoscopic carpal tunnel release device. Hand SurgRehabil 39(3):154–158. https://doi.org/10.1016/j.hansur.2020.01.011

    Article  CAS  Google Scholar 

  22. Seth R, Vijayan R, Khandwala A (2015) Double jeopardy: two episodes of forearm compartment syndrome in the same patient. BMJ Case Rep. https://doi.org/10.1136/bcr-2014-208079

    Article  PubMed  PubMed Central  Google Scholar 

  23. Standring S, Gray H (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Churchill Livingstone, London, p 1551

    Google Scholar 

  24. Stecco C, Macchi V, Porzionato A, Duparc F, De Caro R (2011) The fascia: the forgotten structure. Ital J AnatEmbryol 116:127–138

    Google Scholar 

  25. Stecco C, Tiengo C, Stecco A, Porzionato A, Macchi V, Stern R et al (2013) Fascia redefined: anatomical features and technical relevance in fascial flap surgery. SurgRadiolAnat 35(5):369–376. https://doi.org/10.1007/s00276-012-1058-0

    Article  Google Scholar 

  26. Stecco C, Giordani F, Fan C et al (2019) Role of fascaie around the median nerve in pathogenesis of carpal tunnel syndrome: microscopic and ultrasound study. J Anat 236(4):660–667. https://doi.org/10.1111/joa.13124

    Article  PubMed  Google Scholar 

  27. Won HS, Liu HF, Kim JH, Kwak DS, Chung IH, Kim IB (2016) Intermuscular aponeuroses between the flexor muscles of the forearm and their relationships with the ulnar nerve. SurgRadiolAnat 38(10):1183–1189. https://doi.org/10.1007/s00276-016-1695-9

    Article  Google Scholar 

  28. Yahia LH, Pigeon P, DesRosiers EA (1993) Viscoelastic properties of the human lumbodorsal fascia. J Biomed Eng 15(5):425–429. https://doi.org/10.1016/0141-5425(93)90081-9

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the body donors and their families. We also thank Jose Luis and Gemma Ramón and Eva Sanchez for their assistance in the dissection room and laboratory.

Author information

Author notes

  1. S. Ortiz-Miguel and M. Miguel-Pérez contributed equally to this work.

Authors and Affiliations

  1. Unit of Human Anatomy and Embryology, University of Barcelona, C/Feixa Llarga s/n 08907, L’Hospitalet de Llobregat, Barcelona, Spain

    S. Ortiz-Miguel, M. Miguel-Pérez, J. Navarro, I. Möller & J. L. Agullo

  2. Basic Sciences Department, Universitat Internacional de Catalunya, Barcelona, Spain

    S. Ortiz-Miguel & A. Pérez-Bellmunt

  3. Anesthesia department, Fundació Puigvert, Barcelona, Spain

    J. Ortiz-Sagristà

  4. Unity of Histology, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain

    J. Blasi

  5. Cattedra di Radiologia “R”-DICMI, Universita di Genova, Genoa, Italy

    C. Martinoli

Authors
  1. S. Ortiz-Miguel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Miguel-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Navarro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. I. Möller
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Pérez-Bellmunt
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. L. Agullo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Ortiz-Sagristà
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Blasi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Martinoli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Miguel-Pérez.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ortiz-Miguel, S., Miguel-Pérez, M., Navarro, J. et al. Compartments of the antebrachial fascia of the forearm: clinically relevant ultrasound, anatomical and histological findings. Surg Radiol Anat 43, 1569–1579 (2021). https://doi.org/10.1007/s00276-021-02736-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00276-021-02736-3

Keywords

Search

Navigation