Bilateral Upper-Extremity Acute Exertional Compartment Syndrome: A Case Report

Acute exertional compartment syndrome (AECS) is a condition with the potential for devastating outcomes if not promptly treated. Physicians must maintain a high index of suspicion when evaluating patients presenting with pain, swelling, decreased range of motion, and numbness within a muscle compartment. However, AECS is frequently misdiagnosed due to a multitude of factors, leading to a delay in treatment. In this case report, we would like to shed light on a rare case of bilateral upper-extremity AECS and suggest the treatment paradigm we believe will help prevent negative outcomes.

A previously healthy 33-year-old male presented with bilateral weakness, tingling, tenderness, swelling, and pain upon movement in the trapezius and deltoid muscles. The symptoms started after he performed "burpees" for 18 h following a 12-h forest-fire firefighting shift. The patient's rapidly developing clinical presentation warranted compartmental pressure checks for suspicion of AECS. Being able to quickly determine the elevated trapezius, deltoid, and supraspinatus compartmental pressures allowed us to perform immediate bilateral fasciotomies with delayed primary closure to relieve compartment pressure.

The delay in treatment for patients presenting with AECS is multifactorial and may lead to devastating outcomes if not promptly addressed. The lack of literature regarding bilateral upper-extremity AECS makes the treatment for this condition even more difficult. For our patient, having a proper criterion for performing compartmental pressure checks played a vital role in ensuring an accurate diagnosis and timely medical intervention.