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Facon JB, Mainard N, Louis P, Faure PA, Cognet JM. Ultrasound-guided fasciotomy in forearm chronic exertional compartment syndrome: Preliminary results in 12 cases. HAND SURGERY & REHABILITATION 2024; 43:101719. [PMID: 38782365 DOI: 10.1016/j.hansur.2024.101719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/10/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Abstract
INTRODUCTION Forearm chronic exertional compartment syndrome is a rare condition in athletes and musicians who perform repeated prolonged forced gripping movements. It mainly affects young men, and presents with cramp-like pain, beginning on the anteromedial side of the forearm and progressively extending to the entire circumference, and may be associated with muscle weakness and neurologic symptoms. The objective of this study was to report preliminary results of ultrasound-guided fasciotomy in the treatment of forearm chronic exertional compartment syndrome. MATERIAL AND METHODS A single-center retrospective observational study was conducted. Forearm chronic exertional compartment syndrome was diagnosed on clinical presentation and pathological intramuscular pressure measurement, defined as >30 mmHg at 1 min after effort. The series comprised 7 men, with bilateral involvement. Mean age was 30 years. All patients were motorcyclists. The mean preoperative intramuscular pressure at 1 min after effort was 60.75 mmHg (range: 30-81 mmHg). The main study endpoint was change in pain on visual analogic scale. Secondary endpoints comprised patient satisfaction, change in competitive sports level, and time to return to sport. Complications were noted. RESULTS Six patients (12 forearms) were evaluated. Mean follow-up was 22.5 months (range: 3-48 months). Mean pain rating was 7.3/10 (range: 6-9) preoperatively, and 0/10 postoperatively. All patients were satisfied with the procedure. Mean time to return to sports was 25.5 days (range: 21-30 days). No patients decreased their competitive sports level after the procedure. One patient presented a postoperative hematoma, not requiring surgery. CONCLUSION Ultrasound-guided fasciotomy in the treatment of Forearm chronic exertional compartment syndrome is an innovative technique with promising preliminary results. LEVEL OF EVIDENCE IV; retrospective cohort.
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Affiliation(s)
- Jean-Baptiste Facon
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France.
| | - Nicolas Mainard
- Lille University Center, Jeanne de Flandre Hospital, Department of Pediatric Orthopedics, Avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Pascal Louis
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France
| | | | - Jean-Michel Cognet
- Centre SOS Mains Champagne-Ardenne, Polyclinique Reims-Bezannes, 109 Rue Victor de Broglie, Bezannes, France
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Regas I, Pluvy I, Sakek F, Tuphe P, Ortega P, Guinchard B, Obert L, Lepage D. Epidemiology of upper limb chronic exertional compartment syndrome (CECS) in the French Motorcycle Federation racers: Results of a national questionnaire-based study. HAND SURGERY & REHABILITATION 2021; 40:268-276. [PMID: 33667652 DOI: 10.1016/j.hansur.2020.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/17/2022]
Abstract
Upper limb chronic exertional compartment syndrome (CECS) has been described in amateur and professional motorcycle racers, but there is no published data about its prevalence. The purpose of this study was to define the awareness, prevention and prevalence of this syndrome in licensed motorcycle racers in competition in France. Secondary purposes were to determine the functional impact of CECS and post-treatment outcomes. The 20,641 licensed racers in competition of the French Motorcycle Federation were sent a self-assessment questionnaire about upper limb pain and CECS physical examination findings, functional impact and treatment outcomes. The satisfaction level was assessed after each type of treatment. Acceptability rate was 6.35% with 1311 racers responding. CECS was unknown by 29% of racers. Prevention methods were unknown by 10% of racers. Less than 50% of racers modified their bikes. The prevalence of upper limb CECS in competitive racers was 9%: 8.7% forearm, 0.2% thenar, 0.1% hypothenar and 0.4% first dorsal interosseus compartments. The prevalence was 16% in international level racers, 11% in national level racers and 7.3% in regional level racers. A quarter of racers were satisfied or very satisfied with the outcomes of conservative therapy and rehabilitation. Only 67 racers underwent surgical treatment for their upper limb CECS: 31 by open fasciotomy, 23 by minimally invasive fasciotomy and 13 by endoscopy-assisted compartment release. In these 67 racers, the mean visual analog score for pain improved significantly (p < 0.001 95% CI [3.1-4.5]) with 81% satisfied or very satisfied with surgery outcomes. This epidemiologic self-assessment questionnaire for upper limb CECS is a new concept. This study screened for CECS and offer information regarding evaluation, treatment, and management.
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Affiliation(s)
- Inès Regas
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France.
| | - Isabelle Pluvy
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France
| | - Fiona Sakek
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France
| | - Pierre Tuphe
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France
| | - Pierre Ortega
- Médecin du sport et Président du comité médical de la Fédération Française de Motocyclisme, France
| | - Bruno Guinchard
- Médecin du sport et membre du comité médical de la Fédération Française de Motocyclisme, Besançon, France
| | - Laurent Obert
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France
| | - Daniel Lepage
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CIC IT 808, CHU Minjoz de Besançon, 3, boulevard Alexandre Fleming, 25033 Besançon, France; Université de Franche-Comté Sciences médicales et pharmaceutiques, 19, rue Ambroise Paré, 25000 Besançon, France; Nano médecine, imagerie, thérapeutique-EA 4662 Université de Franche-Comté Sciences médicales et pharmaceutiques, 19 rue Ambroise Paré, 25030 Besançon cedex, France
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