Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome

  • Elizabeth A. Miller
  • Anna L. Walden
  • Tyson K. Cobb


Chronic exertional compartment syndrome (CECS) of the forearm, while uncommon, can occur among elite and professional athletes, especially in the motocross and off-road motorcycle-riding community. Swelling in the forearm muscles occurs with repetitive and sustained hand and forearm muscle activity. This causes increased intra-compartmental pressure in the forearms, which may lead to symptoms of pain, weakness, and paresthesias. Within the motocross-racing community, this condition is more commonly referred to as “arm pump.” Symptoms often present bilaterally as operating the motorbikes requires vigorous repetitive gripping and twisting of both arms. Symptoms typically subside with a period of rest. Surgery is offered to those athletes that do not respond to conservative management. Though an open fasciotomy has typically been the surgical intervention of choice, this chapter will detail the indications, contraindications, surgical technique, tips and tricks, pitfalls, postoperative management, complications, and results of a minimally invasive, endoscopic fasciotomy to treat chronic exertional compartment syndrome which allows patients to return to activity more quickly.


Chronic exertional compartment syndrome Minimally invasive surgery Endoscopic Motocross Arm pump Fasciotomy 



Thanks to Peter Schillaci for his assistance with illustrations and figures and to Elizabeth Elander for her assistance with editing and review of content.

Declaration of Interest: Dr. Tyson Cobb declares that he has a financial relationship with Integra Life Sciences. Anna Walden and Elizabeth Miller declare that they have no commercial associations that might pose a conflict of interest.

Supplementary material

Video 18.1

View over the top of the fascia to confirm no superficial nerves are in harm’s way followed by placement of the scope in the cannula and release of fascia (MP4 65985 kb)

Video 18.2

Clinical case; patient testimonial—5-week post-op at 2016 Monster Energy Motocross Finals (MP4 88546 kb)


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Copyright information

© ISAKOS 2020

Authors and Affiliations

  • Elizabeth A. Miller
    • 1
  • Anna L. Walden
    • 2
  • Tyson K. Cobb
    • 3
  1. 1.Orthopaedic SpecialistsDavenportUSA
  2. 2.Department of ResearchOrthopaedic SpecialistsDavenportUSA
  3. 3.Hand and Upper Extremity ServiceOrthopaedic SpecialistsDavenportUSA

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