Forearm Pain Research Articles

Endoscopic Proximal Median Nerve Decompression: An Alternative Treatment for Pronator Syndrome

Proximal forearm median nerve compressive neuropathy, termed as pronator syndrome, is difficult to diagnose and often overlooked. Its symptoms include vague proximal volar forearm pain that may be associated with paresthesia and numbness in the median nerve distribution. Weakness is typically not present. The treatment of pronator syndrome is largely nonsurgical, consisting of activity modification, anti-inflammatory medication, corticosteroid injections, stretching, and periods of splinting. Surgery is indicated when conservative therapy fails; however, there is no consensus on the treatment approach or technique. Most decompressions are performed using an open technique through a variety of incisions. Recently, endoscopic approaches have drawn an interest. This article describes a technique for endoscopic proximal median nerve decompression that enables the complete decompression of the median nerve in the distal aspect of the arm and proximal aspect of the forearm through a small incision, potentially minimizing surgical morbidity and reducing healing time.

SARS-CoV-2 not detected in pus from forearm abscess in a COVID-19-infected patient

Dear Sir, COVID-19 is transmitted mainly via respiratory droplets, and diagnosis is typically confirmed with polymerase chain reaction (PCR) tests of nasopharyngeal swabs.[1] So far, COVID-19 has been found in faecal, blood and cerebrospinal fluid specimens[2-4] but not in urine, vaginal fluid, or peritoneal fluid.[256] To our knowledge, COVID-19 in limb abscesses has not yet been assessed. In this report, we present a case of incision and drainage performed for a confirmed COVID-19-infected patient with left forearm abscess and describe his postoperative wound management. Informed consent for publication was obtained from the patient. A 37-year-old man with no prior comorbidities had been kept under isolation in a known cluster for COVID-19. He had tested positive for SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) serology five days before presentation, following an acute respiratory infection (ARI). The patient presented with left forearm pain and swelling of two days’ duration. He was noted to be febrile, and physical examination revealed a proximal forearm abscess. Blood investigations found his inflammatory markers to be elevated (C-reactive protein 37.2 mg/L, white blood cell count 13.61 × 109/L). A nasopharyngeal COVID-19 PCR swab test was performed for the patient, which returned positive. Three days after admission (eight days after diagnosis of COVID-19), incision and drainage were performed in a dedicated isolation negative-pressure operating room, with controlled traffic and air flow turbulence via interlocking doors with air drop seals. The operative team consisted of one anaesthetist, two surgeons, one scrub and one circulating nurse. All members donned full personal protective equipment, including a CleanSpace® HALO™ (CleanSpace Technology Pty Ltd, Artarmon, New South Wales, Australia) powered air-purifying respirator as well as goggles or face shields. The decision was made for regional anaesthesia via a nerve block to minimise the risk of aerosolization, as per published recommendations.[7] Elliptical incision and drainage of the 4-cm × 4-cm subcutaneous forearm abscess was performed [Figure 1]. The drained pus and a separate swab of the pus fluid were sent for COVID-19 PCR testing. SNAP™ Therapy System dressing (KCI, San Antonio, TX, USA), a type of negative pressure wound therapy (NPWT), was applied for ease of postoperative wound care and to minimise the frequency of dressing changes. COVID-19 PCR testing was performed with real-time PCR using the A*STAR Fortitude Kit 2.0 (A*STAR, Singapore).Figure 1: Intraoperative photographs show the left forearm abscess (a) before and (b) after incision and drainage.Both pus fluid and pus swab samples tested negative for COVID-19 on PCR testing. The pus fluid culture grew Staphylococcus aureus that was sensitive to cloxacillin, cefazolin, cotrimoxazole, clindamycin and erythromycin. The patient had an uneventful course in the hospital and was discharged to a dedicated quarantine facility on Postoperative Day 2. Follow-up wound assessments found that the postoperative wound was clean and granulating well [Figures 2a & 2b], and the patient was continued on SNAP dressings [Figure 2c].Figure 2: Photographs show the left forearm abscess on (a) Postoperative Day 2, (b) Postoperative Day 6 and (c) with the SNAP Therapy System.To our knowledge, this study is the first to report the evaluation of the presence of COVID-19 in a limb abscess. The findings suggest that transmission of the virus through contact with pus fluid from an infected wound is unlikely. Hence, in cases where resources and manpower are not overwhelmed, provision of optimal patient care is still possible without increased exposure risk to healthcare workers. We suggest evaluating every surgical indication on a case-by-case basis, with careful weighing of surgical risks and benefits in accordance with the availability of local resources. It should be noted that the presence of the virus in pus may be affected by the duration from the initial diagnosis of COVID-19. Literature on the temporal detection of COVID-19 in clinical specimens is still lacking, and further research is warranted. NPWT was our choice of postoperative wound dressing to help provide an occlusive environment to prevent blood contamination, maintain sterility and encourage granulation.[8] It minimises the frequency of dressing change and, hence, healthcare workers’ exposure to a COVID-19-infected patient. The SNAP Therapy System, in particular, has further advantages of being ultraportable, disposable and quiet, allowing better patient convenience and compliance.[9] In conclusion, this report found that COVID-19 was not detected in pus from a forearm abscess and showed the functionality of NPWT in the management of a COVID-19-infected patient. More studies are needed to confirm our preliminary findings and further evaluate transmission of the virus by other routes apart from respiratory droplets.

A Case Report of a Malignant Peripheral Nerve Sheath Tumor of the Paravertebral Region

Introduction: Malignant peripheral nerve sheath tumor (MPNST) is a type of connective tissue cancer, which may also have genetic backgrounds. More than half of patients have neurofibromatosis. The treatment of this tumor is a combination of surgery, radiotherapy, and chemotherapy. As usual, the tumor may be present anywhere with several manifestations. Case Presentation: A 4-year old boy presented with sweating and pain in the right forearm that was diagnosed with MPNST developed in the paravertebral region after laboratory and radiographic evaluation. Conclusions: The patient was treated successfully and followed up for one year without any complications.

Solitary Cervical Spne Osteochondroma Presenting as a Hard-Left Lateral Neck Mass in a Young Lady in a Low Resource Setting: A Case Report

Spinal osteochondroma are basically of two forms, these are spinal osteochondromas in patients with multiple osteochondromas and solitary osteochondromas occurring in the spine. Osteochondromas are more prevalent among the male gender and has an age of onset between 20-30 years. This is a 27-year-old lady that was referred for plain radiograph of the cervical region on account of a hard mass on the left aspect of the neck that was slowly growing for two years duration. He patient also complained of occasional left shoulder, forearm, wrist and hand pain with occasional numbness. The plain radiography was done in both anterior-posterior and lateral projection, showed a soft tissue density fullness and an expansile missed sclerotic and lucent lesion/mass involving the spinous processes of the second to sixth cervical vertebrae. The expansile, and mixed sclerotic and lucent appearance of this area proffered the differential of a solitary cervical spinal osteochondroma. The patient had surgical excision of the tumor, and histopathologic assessment of the tumor confirmed osteochondroma. We report the radiologic finding of a case of Solitary cervical spine osteochondroma in a 27-year-old lady due to its rare nature and presentation

Pseudoaneurysm with Median Nerve Injury Caused by Right Radial Artery Puncture: A Case Report

Background: Pseudoaneurysm with median nerve injury is a serious complication of radial artery puncture. It is very important to summarize the prevention and treatment experience of this complication through case discussion. Case report: A 66-year-old woman was admitted to the hospital because of “paroxysmal chest tightness and suffocation for 5 days.” Coronary angiography was performed. During insertion of the arterial sheath, the patient experienced severe pain in the right forearm, which radiated to the palm. The puncture sheath did not return blood after the sheath core was withdrawn. The sheath was removed and local compression was used to stop bleeding. There was no obvious bleeding at the puncture point, and the compression was removed 6 hours after the procedure. Local swelling and increased tension were seen in the right forearm. At the 1-week follow-up she exhibited swelling, high local tension, small blisters, and bluish-purple skin of the right forearm, with an acceptable right radial artery pulsation. She had severe pain in the affected limb, which radiated to the thumb, index finger, and middle finger. Case discussion: We discuss the causes of and treatment measures for pseudoaneurysm with median nerve injury caused by radial artery puncture.

Extremity foreign body injury presenting years after trauma: 2 case reports and review of literature

Background: Extremity foreign body traumas are common injuries occurring symptoms after 10 years is a rare entity. We are presenting two cases as an example of this situation. Case Presentation: In the first case, a 30-year-old male patient was admitted to the outpatient clinic with complaints of swelling and pain in the right forearm for 3 weeks. The patient had a history of foreign body injury after punching glass 10 years ago. Physical examination of the patient revealed a 4 cm incision scar in the anteromedial of the right forearm with swelling and tenderness. Radiological evaluation revealed a 3 × 1 cm-sized foreign body resembling a glass fragment. In the second case, a 36-year-old male patient was admitted to the clinic with swelling and pain in the left foot. Examination revealed tenderness in the first webspace. The patient had a history of foot injury with a nail 24 years ago. Both patients had removal surgery and complaints regressed in the postoperative clinical follow-up. Conclusion: In these two foreign body injuries, symptoms that occurred years after injury and removal were necessary. It should be always kept in mind that foreign body injuries might cause late injuries, even years after. Therefore, these injuries should always be on mind.

Chronic recurrent multifocal osteomyelitis in a 3.5-year-old boy

We report an extremely rare case of multifocal bone disorder in a 3.5-year-old boy who appeared for left forearm and arm pain and multiple periods of fever with an unusual presentation of lymphoma/leukemia and highlight diagnostic challenges leading to a misdiagnosis, which was then diagnosed and treated for chronic recurrent multifocal osteomyelitis (CRMO). Based on a left arm biopsy and whole-body scans, he was eventually diagnosed with CRMO. Taken together, in this case, we noticed a notable amelioration after a 5-month treatment with nonsteroidal anti-inflammatory drugs on multiple bone pains.

Ultrasound: A Useful Tool in the Diagnosis and Localization of Ulnar Neuropathy at the Elbow.

An 18-year-old, right-hand-dominant, collegiate baseball pitcher presents for evaluation of right elbow and forearm pain for several months following an increase in pitching volume. He describes a progressively worsening aching pain and numbness along the ulnar side of the forearm that radiates into

A Rare Cause of Diffuse Forearm Swelling in an Infant.

1. Matthew Baker, MD* 2. Stephanie Todd, MD, FAAP†,‡ 3. Narendra S. Shet, MD†,‡ 1. *Children’s Hospital Los Angeles, Los Angeles, CA 2. †George Washington University School of Medicine, Washington, DC 3. ‡Children’s National Hospital, Washington, DC A 10-month-old previously healthy girl presents to the emergency department with new-onset fevers and progressive right forearm swelling, pain, and irritability after a diagnosis of a distal forearm fracture in the same arm 2 weeks earlier. Per the parents’ report, they initially sought care 2 weeks earlier when the child refused to bear weight with the right arm while crawling without any known history of trauma. Outside imaging was reported to be notable for nondisplaced distal radial and ulnar fractures, for which the patient was splinted. Although the family denied a history of trauma, due to the unclear etiology of the fractures, an evaluation for possible nonaccidental trauma was performed that was unrevealing, except for the noted radius and ulna fractures. Follow-up 1 week later had revealed a swollen forearm with repeated plain radiographs that demonstrated abundant periosteal reaction along the distal radius and ulna, presumably representing evidence of healing nondisplaced fractures given the duration since the initial injury (Fig 1). The arm remained swollen but compressible and nontender on examination. Due to the fever, as well as continued swelling of the right distal arm with decreased mobility and worsening pain and irritability, the parents present to …

Chronic Exertional Compartment Syndrome of the Forearm: Mini-invasive Technique Using an Endoscopic Soft Tissue Release System.

Chronic exertional compartment syndrome of the forearm is a rare disease characterized by the recurrent onset of forearm pain and progressive weakness during exertion. Over the years many surgical techniques have been reported in literature: wide-open fasciotomy, mini-open fasciotomy, fasciotomy associated with fasciectomy, and mini-invasive endoscopic fasciotomy. Compared with traditional open techniques, mini-invasive techniques are characterized by minimal tissue trauma, less postoperative pain, faster recovery to normal activity and better esthetical result. We describe a mini-invasive endoscopic technique for the treatment of forearm chronic exertional compartment syndrome using the SmartRelease endoscopic tissue release system (MicroAire).

Impact of Biofeedback in the Treatment of Nonspecific Persistent Wrist and Forearm Pain in Adolescents

Biofeedback is a self-regulation technique in which patients learn to control what were once thought to be involuntary bodily processes. The goal of this study was to examine a sample of adolescents with persistent, nonspecific wrist and forearm pain to assess whether biofeedback can improve symptoms. A secondary goal was to identify any shared characteristics. This is a retrospective case series of patients seen by an upper-extremity surgeon and a biofeedback expert at a pediatric hospital from 2011 through 2017. Data collected included Multidimensional Anxiety Scale for Children (MASC) and Children's Depression Inventory (CDI) scores, pain intensity, frequency, and duration; as well as self-report of depression, anxiety, self-harm, and/or suicidal ideation. Additional data included biological sex, brace or orthosis wear, history of injury, prior medical or surgical treatments, and the presence of paresthesias. Biofeedback sessions were held every 1 to 2 weeks, for typically 5 sessions. Sixteen patients met inclusion criteria; 9 completed biofeedback. Eight patients were female (88%) and 1 was male (11%). The dominant extremity was affected in 8 patients (89%). Seven of the 9 patients who completed biofeedback had improvement or resolution of symptoms (78%). Both patients who completed biofeedback but did not have improvement in pain underwent surgery before biofeedback referral. Three patients reported paresthesias; each had an elevated CDI and MASC score (33%). Six patients did not report paresthesias, and one patient had similar elevated CDI and MASC scores CONCLUSIONS: More females than males were seen and referred to biofeedback in this study group. There appears to be an association between underlying anxiety or depression and the report of paresthesias. Biofeedback is an available nonsurgical treatment modality for persistent wrist and forearm pain that should be considered in appropriate patients. Therapeutic V.

Greater Conditioned Pain Modulation Is Associated With Enhanced Morphine Analgesia in Healthy Individuals and Patients With Chronic Low Back Pain.

Conditioned pain modulation (CPM) protocols index magnitude of descending pain inhibition. This study evaluated whether the degree of CPM, controlling for CPM expectancy confounds, was associated with analgesic and subjective responses to morphine and whether chronic pain status or sex moderated these effects. Participants included 92 individuals with chronic low back pain and 99 healthy controls, none using daily opioid analgesics. In a cross-over design, participants attended 2 identical laboratory sessions during which they received either intravenous morphine (0.08 mg/kg) or saline placebo before undergoing evoked pain assessment. In each session, participants engaged in ischemic forearm and heat pain tasks, and a CPM protocol combining ischemic pain (conditioning stimulus) and heat pain (test stimulus). Placebo-controlled morphine outcomes were derived as differences in pain and subjective effects across drug conditions. In hierarchical regressions controlling for CPM expectancies, greater placebo-condition CPM was associated with less subjective morphine unpleasantness (P=0.001) and greater morphine analgesia (P's<0.05) on both the ischemic pain task (Visual Analog Scale Pain Intensity and Unpleasantness) and heat pain task (Visual Analog Scale Pain Intensity, McGill Pain Questionnaire-Sensory, and Present Pain Intensity subscales). There was no moderation by sex or chronic low back pain status, except for the ischemic Present Pain Intensity outcome for which a significant 2-way interaction (P<0.05) was noted, with men showing a stronger positive relationship between CPM and morphine analgesia than women. Results suggest that CPM might predict analgesic and subjective responses to opioid administration. Further evaluation of CPM as an element of precision pain medicine algorithms may be warranted.

The challenge of the surgical treatment of paediatric distal radius/ forearm fracture: K wire vs plate fixation - outcomes assessment.

Aim Distal radius/forearm fractures in adolescent patients remain challenging injuries to treat. Distal radius/forearm bony anatomy is not completely restored with intramedullary K wire fixation. The aim of this study was to compare radiographic and functional outcomes obtained using intramedullary K wire fixation and open reduction and internal fixation in the treatment of distal radius/ forearm fracture. Methods A total of 43 patients who presented with distal radius/ forearm fractures were enrolled and divided into two groups: 23 patients treated with K-wire (IMNK) and 20 patients treated with plate and screws (ORIF). The evaluation criteria were: fracture healing time, objective quality of life measured by the Mayo wrist score (MWS) and quick disabilities of the arm, shoulder and hand score (QuickDash), length time of surgery, complications, sport or play return, forearm visual analogic pain (FVAS), bone healing by radius union scoring system (RUSS). Results In both groups the results obtained were comparable in terms of functional, pain and return to play/sport after the third month after surgery. Bone healing was faster in IMNK than ORIF but without significance (p>0.05). There was less complication in ORIF than IMNK (p<0.05). Conclusion The treatment of adolescent distal radius or forearm fractures remains challenging. One challenge facing the physician is the choice of surgical technique and fixation method, which will be influenced by individual experience and preference. The question of distal radius or forearm fractures in adolescents would be best answered with a prospective randomized study.

Favorite Music Mediates Pain-related Responses in the Anterior Cingulate Cortex and Skin Pain Thresholds.

PurposeMusic therapy is widely used to enhance well-being, reduce pain, and distract patients from unpleasant symptoms in the clinical setting. However, the degree to which music modulates pain perception is unknown. The medial pain pathway including the limbic system is associated with emotion, but how music alters pathway activity is unclear. The aim of the study was to investigate pain thresholds and pain-related responses in the anterior cingulate cortex (ACC) and whether they were modulated when subjects listened to their favorite music genre.Subjects and MethodsFirst, 30 subjects were examined for left forearm pain threshold using electrical stimulation with Pain Vision PS-2011N. The pain thresholds with and without music were compared. Second, when an 80-μA current from Pain Vision was applied to the left ankle of eight women, the pain-related responses of the ACC with and without music were observed with functional magnetic resonance device (fMRI). The changes in the pain-related activity in both parameters were discussed.ResultsThe median pain threshold with favorite music was 38.9 μA, compared to 29.0 μA without, which was significantly different (p<0.0001). The men’s thresholds were significantly higher than women’s both with music (p<0.05) and without music (p<0.01). The pain threshold in women was more strongly affected by music than in men. The fMRI results showed that the pain-related response in the ACC in five of eight subjects was attenuated while they listened to their favorite music. No change was observed in the other three subjects.ConclusionThe present findings suggest that pain perception might be strongly affected by listening to favorite music, possibly through modulation of pain-related responses in the ACC.

Ulnar shaft stress fractures in fast-pitch softball pitchers: a case series and proposed mechanism of injury.

Stress fractures of the upper extremities in athletes are important injuries for radiologists to appreciate despite being far less common than stress fracturesof the lower extremities. Among upper extremity stress fractures, those involving the olecranon have been well described in overhead pitching athletes. Isolated stressfractures of the ulnar shaft however are less commonly reported in the literature and considered to be rare. We have observed a correlation between young patients withulnar shaft stress fractures and the activity of fast-pitch softball pitching. In this series, we present the imaging findings in four cases of ulnar shaft stressfractures in softball pitchers who presented with insidious onset forearm pain. Furthermore, a review of the literature focusing on softball pitching mechanics isprovided to offer a potential underlying mechanism for the occurrence and location of these injuries. An awareness of the imaging appearance of ulnarshaft stress fractures along with an understanding of its proposed mechanism will facilitate accurate and timely imaging diagnosis of this injury by the radiologist.

Bilateral Forearm And Elbow Pain - Tennis

HISTORY: A 75 year-old female tennis player was referred for bilateral elbow pain with suspected lateral epicondylitis. She noted 3 months of pain in her left more than right ventral forearms with radiation into her lateral elbows as well as posterior bilateral shoulder pains. The forearm pain was constant and worsened by single backhand with tennis, lifting weights. She reported reduced grip strength and her racquet falling out of her hands. PHYSICAL EXAMINATION: Cervical range of motion was within functional limits. Elbow examination showed full active and passive range of motion, minimal tenderness along lateral epicondyle and just distal at tendinous origin, and no pain with resisted wrist extension and middle finger extension. She had finger extension weakness without pain bilaterally 3/5 and otherwise motor testing was 5/5 C5-T1 myotomes. Sensation was intact in C5-T1 dermatomes bilaterally. Reflexes were 2+ and symmetric of biceps and brachioradialis and 3+ at the triceps bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Bilateral lateral epicondylitis 2. Cervical spine stenosis with myelopathy 3. Posterior interosseous neuropathy TEST AND RESULTS: Cervical Spine anterior-posterior and lateral radiographs: - Grade 2 anterolisthesis of C7 on T1 is seen with bilateral pars fracture of C7. Moderate multilevel degenerative disc disease. MRI of the Cervical Spine without Contrast: - Advanced facet arthropathy at C7-T1. Anterolisthesis of C7 on T1 causing moderate/severe spinal stenosis with mild cord deformity. Severe bilateral foraminal stenosis at this level. FINAL/WORKING DIAGNOSIS: Cervical central spine stenosis with myelopathy TREATMENT AND OUTCOMES: 1. Neurosurgery referral recommended urgent C7-T1 anterior cervical discectomy and fusion followed by C5-T2 posterior spinal fusion 2. She was placed in hard cervical collar at all times and surgery was performed 1 week after neurosurgery evaluation 3. At 1 week postoperative, patient felt 80% improvement in pain in forearms and elbows along with subjectively improved grip strength 4. She continued the hard cervical collar until repeat radiographs at 6 weeks post surgery. 5. Patient was instructed to avoid playing tennis. She was also informed to avoid bending, twisting of her neck or lifting greater than 5 pounds until further evaluation in 6 week visit.

Anterior Interosseous Nerve Syndrome due to Extravasation of Intravenous Infusion

Anterior interosseous nerve is a motor branch from median nerve. It innervates three muscles, the flexor pollicis longus, the flexor digitorum profundus, and the pronator quadratus muscles in the forearm. Anterior interosseous nerve syndrome refers to a neuropathy affecting this nerve, to develop weakness of innervated muscles. The etiology can be diverse and the pathophysiology is not clearly documented. We report a case of a 67-year-old male patient with diabetes, who presented symptoms of right thumb and index finger weakness, forearm pain, which was in conclusion diagnosed as anterior interosseous nerve syndrome through electrodiagnostic studies. His anterior interosseous nerve syndrome was revealed as due to fluid extravasation. Fluid extravasation can cause various side effects, and peripheral nerve injury is an uncommon side effect. This is a rare case of anterior interosseous nerve syndrome developed from fluid extravasation. Keywords: Neuropathy; Extravasation

Evaluation of Railway Sheathless Access System for Transradial Coronary and Peripheral Interventions

ObjectiveEvaluate efficacy and safety of Railway Sheathless Access System™ (Railway) in the first 200 consecutive cases at our center. BackgroundTransradial Intervention (TRI) is limited by the frequent occurrence of spasm, radial artery occlusion (RAO) and inability to use larger guide catheters (GC). The small size of radial artery (RA) is the primary reason for these limitations. Railway allows downsizing by sheathless GC access with GC of any shape or brand. MethodsProcedural and clinical variables were recorded prospectively for every case with intended use of Railway in the medical records. Hospital wide documentation of arm pain, radial spasm and pre-discharge evaluation of RAO with reverse Barbeau's test was performed by nurses. We retrospectively reviewed the data of the first consecutive 200 cases with the intended use of the Railway. ResultsRailway was used successfully to complete intended procedure in 199 (99.5%) of the 200 patients. Railway was used with a 6 Fr (171) or 7 Fr (29) GC of various shapes to achieve sheathless access in 197 patients and for tracking the GC through severe RA tortuosity or mitral paravalvular leak in the rest. Three patients (1.5%) had spasm and forearm pain, two (1%) patients had small (<5 cm) hematoma, while one (0.5%) patient required access switch over and subsequently had RAO. ConclusionRailway Sheathless Access System can be used routinely for TRI with high success rate and low complication rate.

Fixed Flexion Deformity of the Middle and Ring Fingers in Adult Caused by Intramuscular Hemangioma of the Forearm: A Case Report

Intramuscular hemangioma (IMH) of the upper extremity is extremely rare and mostly found in children. The authors presented a 39-year-old female with an unusual case of fixed flexion deformity of the middle finger and ring finger with deep forearm pain for three years. The patient was diagnosed with IMH of the flexor digitorum superficialis muscle. Excision of the IMH was performed and intra-operatively passive extension of PIP joints was achieved. After 12 months follow-up, the patient was satisfied with the outcomes with no recurrence of flexion contracture. IMH of the upper extremity is an uncommon disease, especially in adults. It should be considered in patient who presented with deep forearm pain and finger flexion deformity. Early investigation should be performed and surgical removal remains the treatment of choice. Furthermore, tendon transfer should be reserved in case of functional deficits. Keywords: Intramuscular hemangioma, Flexion contracture, Forearm, Soft tissue tumor

P1123HEMOPERFUSION COMBINED WITH CRRT IN SEPTIC SHOCK AKI PATIENTS CAUSED BY OSTEOFASCIAL COMPARTMENT SYNDROME

Abstract Background and Aims Although Osteofascial compartment syndrome is rare, it can cause severe complications, including septic shock and acute kidney injury. Most commonly found on the palmar side of the forearm and lower leg. This article reported two cases of septic shock with acute kidney injury caused by osteofascial compartment syndrome, and explored the application of hemoperfusion combined with continuous renal replacement therapy in these two severe patients. Method Two young men, patient A was 38 years old and patient B was 44 years old. Hospitalized in June 2016 and February 2018, respectively. Previous healthy, after questioning, patient A had a history of type 1 diabetes and patient B had a history of gout. Patient A had a history of being beaten by his wife, patient B has no clear history of injury. Patient A showed swelling and pain in the right forearm and patient B showed swelling and pain in the right lower leg. After admission, they quickly developed shock, oliguria, acute kidney injury, multiple organ dysfunction. They were received fluid resuscitation, vasopressors, anti-infectives, respiratory support, nutritional support, and vital signs monitoring. Blood culture of patient A showed a case of group A hemolytic streptococcus, patient B showed streptococcus pyogenes and staphylococcus hemolytic. Patient A was performed CRRT for 3 days, combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Patient B was performed CRRT for 16 days. combined with two hours hemoperfusion (HA-330, Jafron, Zhuhai City, China) on the first day of CRRT, once every 24 hours for two days. Both patients underwent multiple orthopaedic surgeries. Patient A underwent right upper limb amputation and patient B underwent right thigh amputation. Results After hemoperfusion, the amount of norepinephrine was significantly reduced, and the circulation became stable. Finally, two patients improved and were discharged from the hospital, and their renal function returned to normal. Conclusion Once the osteofascial compartment syndrome is diagnosed, the fascia should be decompressed immediately. After local incision and decompression, blood circulation is improved, and a large number of toxins from necrotic tissue enter the blood circulation, which can lead to serious complications such as sepsis, shock, acute kidney injury, and multiple organ failure. Renal replacement therapy and amputation surgery may save lives. Hemoperfusion can reduce the amount of norepinephrine, improve circulation and win surgical opportunities.