Forearm Compartment Syndrome

Exertional forearm compartment syndrome is a rare condition that can occur due to repetitive motions that are characteristic of certain sports, most notably rowing and motocross.

Compartment Syndrome

Compartment syndrome occurs when too much pressure builds up around a muscle, limiting the space and circulation to the muscle tissue. It can occur as either an acute injury (a trauma) or an overuse injury, such as due to repetitive motion. 

Acute compartment syndrome is an uncommon condition that's an emergency and requires urgent surgery. Rapid pressure builds up around the muscle and may cause permanent muscle damage. It can be treated with surgical release of the tissue that surrounds the muscle.

Exercise-induced compartment syndrome, also called chronic compartment syndrome, is much more common. Typical exercise-induced compartment syndrome causes gradually worsening pain of the affected muscle that eventually limits exercise and movement. In rowers and motocross riders, the repetitive use of the forearm muscles can lead to this type of compartment syndrome. 

Chronic 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.

Symptoms of Forearm Compartment Syndrome

The common symptoms of forearm compartment syndrome include:

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

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

The test used to confirm the diagnosis of compartment syndrome is a measurement of pressure in the muscle during intense exercise activity. 

• Athletes are tested by exercising at high intensity, usually with a rowing machine or tank, until pain occurs. 
• A pressure monitor, which is 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 abnormally high.

Other tests such as x-rays, MRI, or nerve conduction tests may be done if needed, depending on the symptoms and physical examination. These tests are almost always normal in patients with exertional compartment syndrome.

Treatment of Exertional Compartment Syndrome

Most athletes start with simple treatments for their exertional compartment syndrome. 

In the case of chronic forearm compartment syndrome, the best treatment is to intermittently adjust the grip of the oar or the grip of the motorcycle to periodically 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, a surgical compartment release can be considered. During the procedure, an incision is made over the muscle, and the fascia (supportive tissue that covers the muscle) is cut. Release of the fascia will provide space for the muscle to expand and swell without pressure building up. 

A Word From Verywell

Exertional forearm compartment syndrome is rarely traumatically induced. Exertional forearm compartment syndrome is an uncommon cause of forearm pain that affects rowers and motocross athletes, but it is not the most common cause of forearm pain—even among these athletes.

Sometimes treatment can be effective with modifications of grip during athletics, while other times surgery may be needed.