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Compartment syndrome of the forearm flexor muscles

coupe3 Effort-related compartment syndrome is a deficit of blood supply to the forearm muscles. To understand this, ...

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Lison RAULT

Definition

Effort-related compartment syndrome is a deficit of blood supply to the forearm muscles. To understand this, you must know that muscles do not form a single mass around the bone but that they are separated from one another in compartments, called muscle compartments, whose borders (or aponeurosis) are not extensible.

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Muscle compartments of the forearm,
by Michel Dufour, Anatomy of the locomotive apparatus, ed. Masson.

During an effort, the muscular activity leads to blood influx in the vessels provoking a temporary increase of 20 to 30% of the muscle volume. However, if these aponevrosis are thick and rigid, the muscle is compressed. The loge, which is too narrow for the muscle, acts like a tourniquet on the venous network, that is no longer able to evacuate the oxygen low blood. As a result the muscle suffocates and pain appears.

Compartment syndrome affects mainly young (20-30 years), athletic men. The main symptom is pain, which appears during physical effort. If you to stop the physical effort the pain disappears in ten or more minutes. The pain may be a sensation of tension, swelling, cramps, burns, compression or of tetanisation. In the worst stages, the pain can be followed by a disruption of the hand’s ability to feel and a loss of muscular strength. If the activities are not reduced, the condition might develop into a state whereby the pain appears faster and disappears more slowly.

Mechanism of the lesion

Effort-related compartment syndrome appears progressively when several factors come together The lack of recovery and of muscular relaxation during intensive exercising is a crucial factor. However, for the symptoms to appear, there must be a thickening of the aponeurosis, which can be caused by microtrauma (repeated impacts on the forearms), scars (compound fractures, surgery, etc.) on persons who have a predisposition for that thickening.

Prevention

If there are no symptoms, regular stretching exercises will maintain the suppleness of the fibrous tissues.
From the first alerts, that is to say the sensation of tension, swelling, cramps, burns, compression or of tetanisation for an effort that is less than what you usually do (except the lack of training!) you must listen to the signs instead of “fighting pain with pain”:
- do not climb with the pain and plan times of recovery until it disappears completely (the suffering of the muscle causes the increase of the swelling and the definitive destruction of cells)
- perform stretching exercises combined with massages in the pain free periods (stretching increases the compression of the vessels) and when not having training sessions. The aim of the massage is to make the aponeurosis more supply by using strong pressure applied in a sliding movement towards where it meets the bone.

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Treatment

Surgery is currently the only solution to continue sports activities at the same level of intensity. The measure of the intramuscular pressure will determine if surgery is necessary. The operation is an aponeurotomy, the incision of an aponeurosis along its entire length, which restores the muscle’s ease. It has good results and enables you to take up a physical activity again after one or two month of convalescence and physiotherapy.

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