Forearm Injury-Weight Lifting

Abstract

HISTORY: A 21 year-old university football player presented with a chief complaint of bilateral upper extremity pain and numbness. Symptoms started insidiously three weeks prior to presentation. Symptoms initially came on after approximately twenty minutes of weight lifting, but had progressed to become present within just a few minutes of weight lifting. He described pain, numbness, and tingling sensations from just below the forearm down through the fingers. Symptoms could last as long as four to five hours following heavy weight lifting. There were no other exacerbating activities. He had no medical problems. PHYSICAL EXAMINATION: The patient presented as a healthy-appearing, muscular man in no distress. Range of motion in the cervical spine, shoulder, elbow, wrist and hands were all full and pain free. Muscle bulk and tone in the upper limbs were normal. Forearm muscles were quite well developed. Light touch testing revealed intact sensation in the C3 through T2 dermatomes and in all peripheral nerve distributions. Strength was 5/5 throughout both upper limbs. Carpal compression test, Phalen's, and Tinel's sign over the median and ulnar nerves were negative on both sides. Pronator compression test caused mild, vague paresthesias in the hands on both sides. DIFFERENTIAL DIAGNOSIS: Peripheral entrapment neuropathy such as carpal tunnel syndrome or pronator syndrome. Chronic exertional compartment syndrome Cervical spine lesion TEST AND RESULTS: Nerve Conduction Studies: Normal Median and Ulnar Nerve Conductions Forearm flexor compartment manometry: A. Pre-exercise pressure: 19 mm Hg B. 1 minute post-exercise pressure: 60 mm Hg C. 3 minute post-exercise pressure: 50 mm Hg FINAL WORKING DIAGNOSIS: Chronic Exertional Compartment Syndrome of the forearm TREATMENT AND OUTCOMES: Bilateral forearm fasciotomies of both the superficial and deep compartments of the forearm flexor muscles were performed. There was complete resolution of symptoms within one month of the surgery. The patient resumed all weight lifting and football activities within 2 months of the surgery without return of symptoms. He has remained symptom free 6 months after surgery.