Acute Exertional Compartment Syndrome of Bilateral Upper Extremities After a Push-up Contest

Acute exertional compartment syndrome (AECS) involving the upper extremity is a rare form of compartment syndrome that occurs after physical activity. Despite its infrequent occurrence, AECS has devastating sequelae, including muscle necrosis and nerve injury. It is imperative to promptly evaluate for AECS in any patient who has notable pain and sensory changes in the context of recent physical activity because of the dire consequences of a missed diagnosis. A 34-year-old man presented to the emergency department with excruciating pain and diffuse paresthesias in his bilateral arms and forearms after participating in a push-up contest. He also had pain with passive stretch of his triceps. Because of these physical examination findings and uncontrollable pain, a clinical diagnosis of AECS was made and was managed with fasciotomies. Postoperatively, the patient's pain and paresthesias slowly resolved, and he was eventually able to return to work at full capacity as a construction worker. This example of AECS of bilateral upper extremities emphasizes that it is a condition that, although rare, is real and must be taken seriously. With appropriate clinical suspicion, a prompt diagnosis can be made, and potentially devastating consequences can be avoided.