Exertional compartment syndrome forearm11/14/2023 Diagnosis can be delayed as long as 22 months in some instances. CECS may present with many different symptoms, appear identical to other etiologies, lack physical exam findings, and appear intermittently as well as transiently. CECS is often overlooked as the cause of muscle pain and paresthesia in the extremities, due to its rarity and diverse manifestation. Increased pressure within compartments leads to transient pain, paresthesia, numbness, and hindrance of muscle activity. However, CECS usually only presents with exercise of the affected compartment, and typically resolves with rest. Acute compartment syndrome of an extremity may develop from either traumatic intracompartmental swelling or external compression. It describes which clinical tests are most helpful for diagnosis and which findings may be distracting.Ĭhronic exertional compartment syndrome (CECS) is classically defined as a condition presenting with recurrent, ephemeral increases in pressures of confined muscle compartments during exercise. This case report and review of the literature may be helpful to the clinician facing similar cases. Clinical RelevanceĬhronic exertional compartment syndrome of the forearm is extremely rare, especially in the female athlete. The three diagnostic criteria we believed to be most helpful in this case, and for future cases of CECS in the forearm, include the clinical presentation, pre- and post-exercise MRI, and pre- and post-exercise compartment pressure measurements. The patient’s symptoms were relieved, and she eventually returned to full play in softball at the university. After the above interventions were attempted and the relative findings of three important modalities were summarized, a fasciotomy and release of the dorsal, volar, and mobile wad compartments was performed. These included cessation of exercise for 1 month, physical therapy, anti-inflammatory medicines, an electromyography/electromyogram (EMG), nerve conduction study (NCS), non-exercise magnetic resonance imaging (MRI) of the forearm, cervical MRI, and cervical computed tomography (CT) angiogram. A broad list of differential diagnoses had to be narrowed down through the presence or absence of relevant findings. Over a six-month period, the patient presented with peculiar presentations and exam results. We discuss the importance of three specific modalities in the diagnosis of this patient, what diagnostic criteria proved less conclusive, and the paradoxical course the syndrome presented with. However, we hope that the presentation of this case and the review of the literature will aid in making swift and accurate diagnoses of CECS in future patients. The rarity of this condition normally places it low on the differential diagnosis. To our knowledge, this is the first case report of a softball player with CECS, with only one similar incident in a major league baseball player. This article presents the case of a collegiate softball pitcher presenting with CECS in her right forearm. However, very few instances include CECS of the upper limb. Chronic exertional compartment syndrome (CECS) is a recognized condition in the lower limb, with many reports in the literature.
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