Parhar Kanwar Partap S, Frolov David, Dolgov Vadim, Quan Michael, Schmitz Miguel A
Washington State University, Elson S. Floyd College of Medicine, Spokane, Washington, USA.
Department of Orthopaedic Surgery, Alpine Orthopaedic and Spine, Spokane, Washington, USA.
J Orthop Case Rep. 2024 Feb;14(2):106-111. doi: 10.13107/jocr.2024.v14.i02.4234.
Acute exertional compartment syndrome (AECS) is a condition with the potential for devastating outcomes if not promptly treated. Physicians must maintain a high index of suspicion when evaluating patients presenting with pain, swelling, decreased range of motion, and numbness within a muscle compartment. However, AECS is frequently misdiagnosed due to a multitude of factors, leading to a delay in treatment. In this case report, we would like to shed light on a rare case of bilateral upper-extremity AECS and suggest the treatment paradigm we believe will help prevent negative outcomes.
A previously healthy 33-year-old male presented with bilateral weakness, tingling, tenderness, swelling, and pain upon movement in the trapezius and deltoid muscles. The symptoms started after he performed "burpees" for 18 h following a 12-h forest-fire firefighting shift. The patient's rapidly developing clinical presentation warranted compartmental pressure checks for suspicion of AECS. Being able to quickly determine the elevated trapezius, deltoid, and supraspinatus compartmental pressures allowed us to perform immediate bilateral fasciotomies with delayed primary closure to relieve compartment pressure.
The delay in treatment for patients presenting with AECS is multifactorial and may lead to devastating outcomes if not promptly addressed. The lack of literature regarding bilateral upper-extremity AECS makes the treatment for this condition even more difficult. For our patient, having a proper criterion for performing compartmental pressure checks played a vital role in ensuring an accurate diagnosis and timely medical intervention.
急性运动性骨筋膜室综合征（AECS）若不及时治疗，可能会导致严重后果。医生在评估出现肌肉骨筋膜室内疼痛、肿胀、活动范围减小和麻木的患者时，必须保持高度的怀疑指数。然而，由于多种因素，AECS经常被误诊，导致治疗延误。在本病例报告中，我们将介绍一例罕见的双侧上肢AECS病例，并提出我们认为有助于预防不良后果的治疗模式。
一名33岁的健康男性，双侧斜方肌和三角肌出现无力、刺痛、压痛、肿胀以及活动时疼痛。这些症状在他连续12小时扑灭森林大火后又进行了18小时的“波比跳”之后出现。患者迅速发展的临床表现因怀疑AECS而需要进行骨筋膜室压力检查。能够快速确定斜方肌、三角肌和冈上肌骨筋膜室压力升高，使我们能够立即进行双侧筋膜切开减压术，并延迟一期缝合以缓解骨筋膜室压力。
AECS患者的治疗延误是多因素的，如果不及时处理，可能会导致严重后果。关于双侧上肢AECS的文献匮乏，使得这种疾病的治疗更加困难。对于我们的患者，有一个合适的骨筋膜室压力检查标准对于确保准确诊断和及时医疗干预起着至关重要的作用。
