![]() 15, 17, 26 Additionally, MRI can accurately exclude other conditions that may mimic CECS, for example, tendonitis, muscle tears and nerve impingements. MRI in chronic compartment syndrome is based on the premise that ischaemic muscle will become oedematous and thus exhibit a more intense T2-weighted (T2W) signal compared with normal muscle. 1, 23, 25 Furthermore, the invasive nature of testing, the associated risks and the lack of an accepted testing technique make intra-compartmental pressure manometry a far from ideal diagnostic tool. 10, 12, 23, 24 Moreover, there is an ever-changing variation in the proposed ‘normal’ compartmental pressure values of the forearm. 8, 12, 24 Various studies confirmed that a significant proportion of patients with clinical and surgically responsive CECS may be misdiagnosed with the use of current intra-compartmental pressure values. 21 These values were proposed for lower leg CECS, and various modifications of the values have been suggested for diagnosis of forearm CECS however, none are universally accepted. 1, 2, 3, 7, 10, 12, 22, 23 Currently, the most widely used method is based on intra-compartmental pressure testing and the values proposed in 1990. 18ĭespite the growing amount of available literature on CECS, controversy remains on how best to diagnose the condition, as well as what diagnostic parameters to use within each specific modality. 18 This points to altered oxygen extraction from the blood by affected muscles as well as altered muscle metabolism, likely because of a chronic state of low-grade ischaemia during exercise. 21 Furthermore, there is evidence that patients with CECS have relatively low levels of oxygenation within muscle compartments during exercise and recovery, as well as deoxygenation early on in exercise, before intra-compartmental pressures rise significantly. 2, 9, 19 Patients with CECS have relatively greater increases in pressure and these pressures also take longer to return to normal after cessation of exercise. 2, 8, 15, 16, 17, 18, 19, 20ĭuring exercise, it is normal for intra-compartmental pressures to rise however, this increased pressure does not usually cause symptoms or altered tissue oxygenation as in patients with CECS. ![]() 2, 4, 7, 8, 10, 11, 12, 14, 15 The pathophysiology of the condition remains incompletely understood but is based on the premise of raised intra-compartmental pressures within a relatively rigid fascial compartment, causing reduced tissue perfusion and subsequent ischaemia. Symptoms include pain, paraesthesia, cramping, a ‘stiff’ feeling of the involved compartment as well as loss of grip strength. 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Symptoms in patients with CECS typically occur during exertion and resolve with rest. 1 Most of the literature regarding this condition is in the form of case studies or case series, and mostly include patients such as rowers, motorcyclists, rock-climbers, resistance trainers, etc., who undertake strenuous, repetitive forearm movements. Chronic exertional compartment syndrome (CECS) of the forearm is a rare entity with the first case only being described in 1983.
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