Endoscopic aponeurotomy for chronic exertional compartmental syndrome of the forearm: report of 41 cases

Abstract

Chronic exertional compartment syndrome of the forearm is probably underdiagnosed as a cause of forearm pain in the sportsman. Its pathological basis is a critical elevation of extracellular pressure. The clinical diagnosis is confirmed by measurements of intracompartmental pressures. We described a reliable original method of endoscopically assisted superficial fasciotomy for treating chronic exertional compartment syndrome of the forearm. The goal of the study is the physiological and clinical validation of this technique. Retrospective cohort study after the anatomical assessment of the feasibility of our endoscopically assisted fasciotomy. Review of 41 forearm decompressions in 25 patients (23 sportsmen and 2 musicians). Follow-up of 6 months to 9 years. Eighty-eight percent reported an excellent or good outcome with significant reduction of pain during exercise. Three patients noted the return of their compartment syndrome and this was confirmed by new measurements of intramuscular pressure. Two of them underwent fasciectomy with excision of a hypertrophic scar of the superficial aponevrosis to good effect. Two hematomas and 2 lateral epicondylitis with no adverse effect on the final result. Endoscopically assisted fasciotomy is a reliable technique for reducing pain in chronic compartment exertional syndromes. It allows the large majority of patients to return to sports. It is our first choice indication in young sportsmen for syndromes of the forearm (anterior and/or posterior compartment). The limit of the technique is the current knowledge of collagenic tissues pathology as a cause of recurrence with hypertrophic aponevrotic scars.