Long term functional outcomes after minimally invasive surgical decompression in upper limb chronic exertional...

Chronic exertional compartment syndrome (CECS) of the upper limbs is less well known than its equivalent in the lower limbs, thus its diagnosis is often delayed. Our goals were to evaluate the impact of CECS on activities of daily living and work-related activities and to report the functional outcomes after minimally invasive fasciotomy. This was a retrospective study of patients with CECS of the upper limb who were operated at two hospitals between 2008 and 2019. Thirty patients were reviewed an average of 5 years after minimally invasive fasciotomy: 26 had CECS of the forearm, 3 of the thenar compartment and 1 of the first interosseous compartment. For the evaluation, patients were asked to assess their pain on a visual analog scale (VAS), complete the QuickDASH questionnaire and rate their satisfaction with the outcome. Preoperative pain on the VAS was 7.45/10 with a negative impact on activities of daily living in 97% of patients, and on work-related activities in 77% of patients with 17% requiring a career change. The mean time to surgical treatment was 5 years. The mean QuickDASH at the final assessment was 6.0 (0-31.8) with a significant decrease in pain on VAS of 1.9/10 (p < 0.01). Seventy-seven percent of patients had very good results while 13% had good results. Full healing was achieved in 63% of patients and physical performance improved in 50%. Seventy-seven percent of patients were either satisfied or very satisfied with the outcome. One patient had a recurrence requiring surgical revision. CECS affects athletes of all levels and impacts both activities of daily living and work-related activities. We need to greatly expand our education and prevention efforts for CECS. Mini-open fasciotomy yields good results.