Chronic exertional compartment syndrome as a cause of bilateral forearm pain

Abstract

The patient, a 47-year-old man, presented with a 7-year history of forearm pain. He noted that his symptoms were worse after lifting or driving, and he was unable to drive for more than a few minutes without tingling and pain. His symptoms resolved with rest but recurred with physical activity. There was no history of trauma or joint swelling. A left carpal tunnel release had been performed 8 years previously. His medical history was otherwise unremarkable, there were no other current health problems, and he was not taking any medication. He had regularly trained with weights until his symptoms prevented this. Results of a general physical and neurologic examination were normal. His forearms were noted to be well developed and bulky. In view of his symptoms, dynamic (preand post-exercise) magnetic resonance imaging (MRI) was performed, and the resultant findings led to the measurement of compartment pressures, via needle intracompartmental pressure monitoring. The left forearm showed a resting pressure of 33 mm Hg, increasing to 144 mm Hg after several minutes of repetitive wrist flexion and extension (which also caused his symptoms to occur). After 2 minutes of rest the pressure decreased to 62 mm Hg. The patient underwent fasciotomy of the forearm extensors (at which the fascia was noted to be thickened), after which his symptoms resolved completely. He later underwent fasciotomy of the right forearm extensors and has resumed unlimited physical activity. Radiologic findings