Two cases of thenar compartment syndrome from blunt trauma

Compartment syndrome is a limb-threatening complication associated with extremity trauma. The existence of compartment syndrome involving the thenar space is considered controversial and has not been reported in association with blunt traumatic injury of the hand.

We report two cases involving compartment syndrome of the thenar space in association with blunt trauma to the hand.

Patient A was a young man who suffered a fracture/dislocation of the right thumb after a fall. Compartment pressures were measured at 70 mm Hg in the thenar space. The patient underwent successful fasciotomy and K-wire stabilization of the thumb and was ultimately discharged with good function on day 4. Patient B suffered a crush injury of the right hand and presented with diffuse swelling associated with median nerve paresthesia. Radiographs revealed a fracture of the triquetrum and of the base of the third metacarpal bone. The patient underwent multiple fasciotomies of the hand, including a release of the thenar space. He was discharged on day 2 with improving function of his thumb.

Compartment syndrome of the thenar space may be more common than previously reported. Given the limited time frame after which permanent damage occurs, clinicians should consider measurement of thenar compartment pressures in high-risk injuries.