Ultrasound-guided fasciotomy for chronic exertional forearm compartment syndrome: a cadaveric feasibility study

Chronic exertional forearm compartment syndrome is observed in patients who engage in physical activity requiring repetitive isometric muscular effort of the wrist during prolonged grasping. Open fasciotomy was considered as the gold-standard treatment, for its ability to release all compartments. However, its invasiveness means that high-level athletes have to abstain from competition for a long period of time. For this reason, minimally invasive techniques have been developed, to allow faster recovery. The objective of this cadaveric study was to evaluate the feasibility and reproducibility of ultrasound-guided palmar fasciotomy in the treatment of chronic exertional forearm compartment syndrome.

Surgery consisted in ultrasound-guided palmar fasciotomy of the superficial anterior compartment, using a single minimally invasive approach. Twenty forearms were then dissected by an independent operator, (1) to check complete fasciotomy and (2) to screen for iatrogenic lesions on the tendons, veins and superficial sensory branches.

Sixteen fasciotomies were total and 4 partial: i.e., a release rate of 80%. The superficial sensory branches were intact, and notably the branches of the medial cutaneous nerve of the forearm. Mean surgery time was 9 min, progressively decreasing with the repetition of the ultrasound-guided procedure.

Ultrasound-guided fasciotomy in the management of chronic exertional forearm compartment syndrome appears to be a simple, effective, safe and reproducible technique.