Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders

Ultrasound-guided fasciotomy in forearm chronic exertional compartment syndrome: Preliminary results in 12 cases

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.

NanoScope Arthroscopy: Lessons Learned in the First 75 Cases

Background  The field of arthroscopy has exponentially grown in the past decade, especially in the realm of upper extremity surgery. Description  The use of smaller cameras and further advancements in arthroscopy technology have allowed innovative expansion in the application of arthroscopy in small joints. Clinical Relevance  Included in the advancements is the NanoScope, a 1.9-mm flexible scope specifically designed for small joint visualization.

MRI findings in chronic exertional compartment syndrome of the forearm: Using signal intensity ratio as a diagnostic tool

BACKGROUND

Chronic exertional compartment syndrome (CECS) of the forearm is a rare but important cause of morbidity amongst athletes involved in strenuous upper limb activities. The diagnosis remains challenging due to the absence of objective, reproducible diagnostic studies.

OBJECTIVES

To assess and quantify signal intensity (SI) changes of involved muscles in patients with CECS of the forearm compared to healthy control subjects competing in similar sporting disciplines. Also, to objectively measure MRI SIs within muscle compartments when using a pre- and post-exercise regime and calculating a signal intensity ratio (SIR) between post- and pre-exercise studies.

METHOD

The study retrospectively examined MRI scans of patients treated for CECS of the forearm and compared these to the MRI scans of asymptomatic high-level rowers. A specific, reproducible pre- and post-exercise MRI scanning protocol was utilised in both patient and control subjects between 2011 and 2020. Signal intensities were evaluated pre- and post-exercise in involved muscle groups and ratios were calculated.

RESULTS

A total of 86 SIs were measured (43 pre- and 43 post-exercise) in nine study participants (five patients and four controls). After post:pre-exercise comparisons, a statistically significant difference was found between control and patient groups (p = 0.0010). The extensor carpi radialis, flexor digitorum profundus and flexor digitorum superficialis muscles were most commonly involved.

CONCLUSION

This study confirms that significant SI changes are apparent in patients with CECS of the forearm when making use of a standardised pre- and post-exercise MRI protocol. Furthermore, SIR may be used to accurately diagnose CECS of the forearm.

Recovery and Fatigue Behavior of Forearm Muscles during a Repetitive Power Grip Gesture in Racing Motorcycle Riders

Despite a reduction in the maximal voluntary isometric contraction (MVC_isom) observed systematically in intermittent fatigue protocols (IFP), decrements of the median frequency, assessed by surface electromyography (sEMG), has not been consistently verified. This study aimed to determine whether recovery periods of 60 s were too long to induce a reduction in the normalized median frequency (MF_EMG) of the flexor digitorum superficialis and carpi radialis muscles. Twenty-one road racing motorcycle riders performed an IFP that simulated the posture and braking gesture on a motorcycle. The MVC_isom was reduced by 53% (p < 0.001). A positive and significant relationship (p < 0.005) was found between MF_EMG and duration of the fatiguing task when 5 s contractions at 30% MVC_isom were interspersed by 5 s recovery in both muscles. In contrast, no relationship was found (p > 0.133) when 10 s contractions at 50% MVC were interspersed by 1 min recovery. Comparative analysis of variance (ANOVA) confirmed a decrement of MF_EMG in the IFP at 30% MVC_isom including short recovery periods with a duty cycle of 100% (5 s/5 s = 1), whereas no differences were observed in the IFP at 50% MVC_isom and longer recovery periods, with a duty cycle of 16%. These findings show that recovery periods during IFP are more relevant than the intensity of MVC_isom. Thus, we recommend the use of short recovery periods between 5 and 10 s after submaximal muscle contractions for specific forearm muscle training and testing purposes in motorcycle riders.

Muscle Fatigue When Riding a Motorcycle: A Case Study

This case study was conducted to assess muscle pattern, as measured by surface electromyography (sEMG), and its changes during a controlled superbike closed-road track training session. The sEMG signals were recorded unilaterally from biceps brachii (BB), triceps brachii (TB), anterior and posterior part of the deltoid (DA and DP respectively), flexor digitorum superficialis (FS), extensor carpi radialis (CR), extensor digitorum communis (ED) and pectoralis major (PM) during three rounds of 30 min. sEMG signals selected for analysis came from the beginning of the braking action to the way-out of the curves of interest. Considering the laps and rounds as a whole and focusing on the forearm muscles, ED was more systematically (84%) assigned to a state of fatigue than FS (44%) and CR (39%). On the opposite, the TB and DP muscles showed a predominant state of force increase (72%). Whereas the BB showed alternatively a state of fatigue or force increase depending on the side of the curve, when taking into account only the sharpest curves, it showed a predominant state of force increase. In conclusion, the fact that forearm muscles must endure a long-lasting maintenance of considerable activity levels explains why they easily got into a state of fatigue. Moreover, TB and DA are particularly relevant when cornering.

Forearm muscles fatigue induced by repetitive braking on a motorcycle is best discriminated by specific kinetic parameters

Maneuvering a motorcycle in racing conditions or for prolonged time is sufficiently demanding that on many occasions forearm muscles reach a state of functional failure when riders cannot properly brake or operate the throttle. This study intends to discriminate which ones of the several dynamometric parameters used in the literature to characterize the Force-time (F-t) curve during voluntary contractions are more sensitive to neuromuscular fatigue in simulated motorcycle-riding conditions. Thirty-three adults performed an intermittent fatiguing protocol (IFP) that simulated the brake-pulling and throttle-twisting actions, by using a hydraulic system equipped with a pressure sensor. Sixty pressure-time (P-t) curve parameters, including the rate of pressure development (RPD) and area under the curve were measured to characterize the time course of the braking maximal voluntary contraction (MVC). Two types of variables were used to analyze the P-t curve: 1) Times interval (from 0 to 30-50-100-500-1000 and 2000 ms); 2) Percentages of MVC (10-30-60-90%MVC). Overall significant (p ≤ 0.05) fatigue-related declines were observed only at time intervals longer than 100 ms and contraction intensities higher than 30%MVC. Strong and significant linear declines (p < 0.001) were observed at 500 ms and 1 s for normalized pressures, as well as for the ratio RPD_60%MVC/MVC (p < 0.003) throughout the IFP. Our results suggest considering RPD at time windows of 0–500 ms and 0–1 s, and contraction intensities comprised between 30% and 60% of MVC, as more suitable criteria to study fatigue-related decrements in performance rather than the classical MVC force.

Chronic exertional compartment syndrome of the forearm: a systematic review

The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm.

We searched Medline (PubMed), Web of Science, Embase and Scopus databases on 8 July 2020. Twelve studies were included in this review.

We assessed the quality of the studies using the Coleman Methodological Score.

Data on demographic features, operative readings, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to sport activity, and outcome measures were recorded.

In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications.

Cite this article: EFORT Open Rev 2021;6:101-106. DOI: 10.1302/2058-5241.6.200107

Cubital tunnel syndrome with small occult ganglion: A case report of bike rider

Cubital tunnel syndrome, the second-most common peripheral compression neuropathy, is associated with dynamic pressure in the cubital tunnel with the elbow flexion position. Medial elbow ganglion originated from the ulnohumeral joint causing cubital tunnel syndrome has been reported. This report describes the case of a 48-year-old man who developed numbness in his left ring and little finger after prolonged motorbike touring. He gradually showed decreased hand grip strength with medial elbow joint pain. Ultrasonography and magnetic resonance images revealed small occult ganglion at the medial side of elbow joint. Surgical resection of ganglion and ulnar nerve decompression relieved the ulnar neuropathy symptom. Prolonged motorbike riding while maintaining the elbow flexion position might exacerbate the symptom of cubital tunnel syndrome in patients with even a small space-occupying lesion such as the small occult ganglion.

Mini-Open Surgical Fasciotomy for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Adolescents

OBJECTIVE

Evaluate treatment and outcome of mini-open fasciotomy (MOF) in a population of adolescent motorcycling racers affected by forearm chronic exertional compartment syndrome (CECS).

DESIGN

Prospective case series.

SETTING

University hospital/private practice.

PATIENTS

Nine professional motorcycling adolescents were diagnosed with forearm CECS. All were treated with MOF between 2007 and 2012 and followed for a minimum of 5 years (range 5-10 years). Age, sex, body mass index, laterality, and profession were recorded.

INTERVENTIONS

A MOF to obtain decompression of all compartments was performed in all patients.

MAIN OUTCOME MEASURES

Visual analog scale; a subjective scale to measure strength; and Quick-DASH functional scores. Time to resume full riding capacities as the short-term evaluation.

RESULTS

A significant decrease in visual analog scale (P < 0.001) and Quick-DASH (P < 0.001) scores was observed in the first 3 months, stabilizing during follow-up (P = 0.521; P = 0.217). Average time to return to sport was 2.8 ± 1 week. No symptom recurrence was reported, but one patient suffered a minor complication. There were no cases of infection, hematoma, or peripheral nerve injury.

CONCLUSIONS

We assess that MOF can be a valid alternative for the treatment of forearm CECS in adolescent competitive motorcycling racers, as demonstrated by the good success rate and minimal incidence of complications during follow-up.

LEVEL OF EVIDENCE

IV, case series.