Abstract
BackgroundChronic 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.ObjectivesTo 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.MethodThe 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.ResultsA 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.ConclusionThis 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.
Highlights
Chronic exertional compartment syndrome (CECS) of the forearm is a rare entity with the first case only being described in 1983.1 Most of the literature regarding this condition is in the form of case studies or case series, and mostly include patients such as rowers, motorcyclists, rock-climbers, resistance trainers, etc., who undertake strenuous, repetitive forearm movements.[2,3,4,5,6,7,8,9,10,11,12,13,14]
Demographics of all study participants, as well as the arm(s) that exhibited signal intensity (SI) changes on post-exercise imaging, are detailed in Table 2 and Figure 1. As both arms were involved in some individuals, the sum of individual arms affected is more than the total number of participants
This study confirms that SI changes are present in the forearms of both patients confirmed with CECS of the forearm as well as in healthy control subjects who partake in similar high-intensity forearm activities
Summary
Chronic exertional compartment syndrome (CECS) of the forearm is a rare entity with the first case only being described in 1983.1 Most of the literature regarding this condition is in the form of case studies or case series, and mostly include patients such as rowers, motorcyclists, rock-climbers, resistance trainers, etc., who undertake strenuous, repetitive forearm movements.[2,3,4,5,6,7,8,9,10,11,12,13,14] Symptoms in patients with CECS typically occur during exertion and resolve with rest. Paraesthesia, cramping, a ‘stiff’ feeling of the involved compartment as well as loss of grip strength.[2,4,7,8,10,11,12,14,15] The pathophysiology of the condition remains incompletely understood but is based on the premise of raised intra-compartmental pressures within a relatively rigid fascial compartment, causing reduced tissue perfusion and subsequent ischaemia.[2,8,15,16,17,18,19,20]. The diagnosis remains challenging due to the absence of objective, reproducible diagnostic studies
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