Cole Austin, Hiatt John L, Arnold Christopher, Sites Terry, Ylanon Ramon
University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, USA.
University of Arkansas, Fayetteville, USA.
Sports Med Open. 2017 Dec;3(1):11. doi: 10.1186/s40798-017-0080-5. Epub 2017 Mar 17.
Chronic exertional compartment syndrome (CECS) is a recognized condition in the lower limb, with many reports in the literature. However, very few instances include CECS of the upper limb. This article presents the case of a collegiate softball pitcher presenting with CECS in her right forearm. To our knowledge, this is the first case report of a softball player with CECS, with only one similar incident in a major league baseball player.
The rarity of this condition normally places it low on the differential diagnosis. However, we hope that the presentation of this case and the review of the literature will aid in making swift and accurate diagnoses of CECS in future patients. We discuss the importance of three specific modalities in the diagnosis of this patient, what diagnostic criteria proved less conclusive, and the paradoxical course the syndrome presented with.
Case Review RESULTS: Over a six-month period, the patient presented with peculiar presentations and exam results. A broad list of differential diagnoses had to be narrowed down through the presence or absence of relevant findings. These included cessation of exercise for 1 month, physical therapy, anti-inflammatory medicines, an electromyography/electromyogram (EMG), nerve conduction study (NCS), non-exercise magnetic resonance imaging (MRI) of the forearm, cervical MRI, and cervical computed tomography (CT) angiogram. After the above interventions were attempted and the relative findings of three important modalities were summarized, a fasciotomy and release of the dorsal, volar, and mobile wad compartments was performed. The patient's symptoms were relieved, and she eventually returned to full play in softball at the university.
The three diagnostic criteria we believed to be most helpful in this case, and for future cases of CECS in the forearm, include the clinical presentation, pre- and post-exercise MRI, and pre- and post-exercise compartment pressure measurements.
Chronic exertional compartment syndrome of the forearm is extremely rare, especially in the female athlete. This case report and review of the literature may be helpful to the clinician facing similar cases. It describes which clinical tests are most helpful for diagnosis and which findings may be distracting.
慢性运动性骨筋膜室综合征（CECS）是下肢一种已被认知的病症，文献中有诸多报道。然而，上肢的CECS病例却极为罕见。本文介绍了一名大学垒球投手右前臂出现CECS的病例。据我们所知，这是首例垒球运动员患CECS的病例报告，在一名美国职业棒球大联盟球员中仅有一例类似情况。
这种病症的罕见性通常使其在鉴别诊断中处于较低优先级。然而，我们希望通过展示该病例并回顾文献，有助于未来对CECS患者做出快速准确的诊断。我们讨论了三种特定检查方法在该患者诊断中的重要性、哪些诊断标准的结论性较差以及该综合征呈现出的矛盾病程。
病例回顾
在六个月的时间里，该患者呈现出特殊的症状表现和检查结果。必须通过相关发现的有无来缩小广泛的鉴别诊断范围。这些措施包括停止运动1个月、物理治疗、使用消炎药物、进行肌电图/肌电图（EMG）检查、神经传导研究（NCS）、前臂非运动状态下的磁共振成像（MRI）、颈椎MRI以及颈椎计算机断层扫描（CT）血管造影。在尝试了上述干预措施并总结了三种重要检查方法的相关结果后，进行了筋膜切开术并松解了背侧、掌侧和活动肌束骨筋膜室。患者的症状得到缓解，最终恢复了在大学垒球队的全勤训练。
我们认为在该病例以及未来前臂CECS病例中最有帮助的三个诊断标准包括临床表现、运动前后的MRI以及运动前后的骨筋膜室压力测量。
前臂慢性运动性骨筋膜室综合征极为罕见，尤其是在女性运动员中。本病例报告及文献回顾可能对面对类似病例的临床医生有所帮助。它描述了哪些临床检查对诊断最有帮助以及哪些发现可能会产生干扰。
