Forearm Compartment Syndrome

There are quite a few unusual orthopedic problems and conditions that rarely occur, with the exception of some specific sports. One particular injury is called forearm compartment syndrome. Forearm compartment syndrome is almost unheard of in most people but can occur in some sports, most notably in rowing (crew) and motocross riders.

Compartment syndrome is an unusual condition that occurs when too much pressure builds up around a muscle, limiting the circulation to the muscle tissue. Compartment syndrome can occur as either an acute injury (a trauma) or as an overuse injury (often during sports). Acute compartment syndrome is an emergency that requires urgent surgery. Rapid pressure builds up around the muscle may cause permanent muscle damage if not urgently addressed by surgically releasing the tight tissue around the muscle.

Much more common is exercise-induced compartment syndrome, also called chronic compartment syndrome, that occurs during exercise. Typical exercise-induced compartment syndrome causes a gradual increase of pain in the affected muscle that eventually limits continued exercise participation. Specific muscles may be affected by exercise-induced compartment syndrome. In rowers and motocross riders, the repetitive use of the forearm muscles can cause this type of compartment syndrome. Forearm compartment syndrome has also been rarely reported in the medical literature in other types of athletes including a kayak paddler, a baseball pitcher, and an elite swimmer.

The common symptoms of forearm compartment syndrome include:

• Pain in the forearm
• Swelling/tightness of forearm muscles
• Relief of discomfort with rest
• Numbness and tingling in the forearm and hand

Most often exercise-induced forearm compartment syndrome causes very predictable symptoms. This means that most athletes know how long they can participate in their activity, and they typically find their symptoms resolve quickly with rest.

The test used to confirm the diagnosis of compartment syndrome is to measure the pressure in the muscle during intense exercise activity. When I test athletes, I often accompany them to the rowing machine or tank, allow them to exercise at high intensity until pain occurs. A pressure monitor (shaped like a needle) is inserted into the muscle. The pressure measurement is compared to the resting pressure of the muscle to determine if the pressure increase is too much.

Other tests such as x-rays, MRI, or nerve conduction tests may be performed if there is a question of the cause of the problem, however, these tests are almost always normal in patients with compartment syndrome.

Most athletes start with simple treatments for their compartment syndrome. In the case of forearm compartment syndrome, the best treatment is often to adjust the grip of the oar or the grip of the motorcycle to change the stress on the forearm muscles. Many athletes find these grip changes are sufficient to allow them to continue participation in their sport. Adjusting grip pressure can also be helpful, although many athletes find it hard, especially during high-intensity activity.

When grip adjustments are insufficient treatment, and the compartment pressure test verifies the diagnosis of elevated compartment pressures with exercise activity, a surgical procedure called a compartment release can be considered. The procedure is straightforward and involves making an incision over the muscle, and cutting the tight tissue (called fascia) that covers the muscle. Release of the fascia will allow for the muscle to expand and swell without pressure building up. 

Forearm compartment syndrome is an unusual cause of forearm pain seen in a distinct group of athletes. With most all case reports of exercise-induced forearm compartment syndrome confined to rowers and motocross athletes and only rare cases of traumatically induced forearm compartment syndrome, this condition occurs infrequently. Other causes of forearm pain are much more common, but in individuals with ongoing forearm pain after specific athletic activity, this condition can be considered. Sometimes treatment can be effective with modifications of grip during athletics, while other times surgery is the only effective treatment.