Objective: Chronic exertional compartment syndrome (CECS) of the forearm is a rare and underdiagnosed condition that mainly affects young athletes. Minimally invasive endoscopic surgical treatment has been shown to reduce complication rates and allow for an expedited return to activity. Evidence on the outcomes of single-portal endoscopic fasciotomy for forearm CECS remains limited. The aim of this study was to describe the results of single-portal endoscopic-assisted fasciotomy in treating forearm CECS.
Methods: A total of 17 patients (21 forearms) diagnosed with forearm CECS and treated with single-portal endoscopic-assisted fasciotomy were included in this study. Intracompartmental pressure was preoperatively measured at rest, on exertion, and at 5 min postexertion. Additionally, pain intensity and physical function were evaluated using the visual analog scale (VAS) and the Disability of Arm, Shoulder, and Hand (DASH) questionnaire, respectively, before surgery and 4 weeks after surgery.
Results: Preoperative assessments revealed a mean intracompartmental pressure of 15.7 ± 1.5 mmHg at rest, 77.7 ± 3.8 mmHg on exertion, and 22.9 ± 2.3 mmHg at 5 min postexertion. The mean preoperative VAS score was 7.6 ± 1.1, which dropped to 0.1 ± 0.35 after surgery. The mean DASH score was 29.8 ± 3.0 preoperatively and 4.6 ± 2.4 postoperatively. Both VAS and DASH scores were significantly lower after surgery (paired t test, p < 0.001). No major adverse effects were reported. Patients returned to light cycling at an average of 10 ± 3.8 days and resumed usual daily activities within 18.2 ± 1.9 days on average.
Conclusions: Endoscopic compartment decompression through a single port proved to be an effective and safe surgical treatment technique in patients with forearm CECS, thus deserving serious consideration as a replacement for classic fasciotomy.
Level of Evidence: III.
| [1] |
U. Rydholm, C. O. Werner, and P. Ohlin, “Intracompartmental Forearm Pressure During Rest and Exercise,” Clinical Orthopaedics and Related Research 175 (1983): 213–215.
|
| [2] |
B. Liu, G. Barrazueta, and D. E. Ruchelsman, “Chronic Exertional Compartment Syndrome in Athletes,” Journal of Hand Surgery 42, no. 11 (2017): 917–923.
|
| [3] |
K. Sindhu, B. Cohen, J. A. Gil, T. Blood, and B. D. Owens, “Chronic Exertional Compartment Syndrome of the Forearm,” Physician and Sports Medicine 47, no. 1 (2019): 27–30.
|
| [4] |
M. A. Martens and J. P. Moeyersoons, “Acute and Recurrent Effort-Related Compartment Syndrome in Sports,” Sports Medicine 9, no. 1 (1990): 62–68.
|
| [5] |
J. P. Moeyersoons and M. Martens, “Chronic Compartment Syndrome: Diagnosis and Management,” Acta Orthopaedica Belgica 58, no. 1 (1992): 23–27.
|
| [6] |
R. A. Pedowitz, A. R. Hargens, S. J. Mubarak, and D. H. Gershuni, “Modified Criteria for the Objective Diagnosis of Chronic Compartment Syndrome of the Leg,” American Journal of Sports Medicine 18, no. 1 (1990): 35–40.
|
| [7] |
H. Zandi and S. Bell, “Results of Compartment Decompression in Chronic Forearm Compartment Syndrome: Six Case Presentations,” British Journal of Sports Medicine 39, no. 9 (2005): e35.
|
| [8] |
J. Wittstein, C. T. Moorman,, and L. S. Levin, “Endoscopic Compartment Release for Chronic Exertional Compartment Syndrome: Surgical Technique and Results,” American Journal of Sports Medicine 38, no. 8 (2010): 1661–1666.
|
| [9] |
J. S. Brown, P. C. Wheeler, K. T. Boyd, M. R. Barnes, and M. J. Allen, “Chronic Exertional Compartment Syndrome of the Forearm: A Case Series of 12 Patients Treated With Fasciotomy,” Journal of Hand Surgery, European Volume 36, no. 5 (2011): 413–419.
|
| [10] |
J. W. Harrison, P. Thomas, A. Aster, G. Wilkes, and M. J. Hayton, “Chronic Exertional Compartment Syndrome of the Forearm in Elite Rowers: A Technique for Mini-Open Fasciotomy and a Report of Six Cases,” Hand (New York, N.Y.) 8, no. 4 (2013): 450–453.
|
| [11] |
C. Jans, G. Peersman, B. Peersman, T. Van Den Langenbergh, J. Valk, and T. Richart, “Endoscopic Decompression for Chronic Compartment Syndrome of the Forearm in Motocross Racers,” Knee Surgery, Sports Traumatology, Arthroscopy 23, no. 9 (2015): 2522–2527.
|
| [12] |
S. Barrera-Ochoa, S. Haddad, E. Correa-Vázquez, et al., “Surgical Decompression of Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Racers: Comparative Long-Term Results of Wide-Open Versus Mini-Open Fasciotomy,” Clinical Journal of Sport Medicine 26, no. 2 (2016): 108–114.
|
| [13] |
L. Pegoli, A. Pozzi, and G. Pivato, “Endoscopic Single Approach Forearm Fasciotomy for Chronic Exertional Compartment Syndrome: Long-Term Follow-Up,” Journal of Hand Surgery (Asian-Pacific Volume) 21, no. 1 (2016): 8–12.
|
| [14] |
N. Maffulli, M. Loppini, F. Spiezia, A. D'Addona, and G. D. Maffulli, “Single Minimal Incision Fasciotomy for Chronic Exertional Compartment Syndrome of the Lower Leg,” Journal of Orthopaedic Surgery and Research 11, no. 1 (2016): 61.
|
| [15] |
G. Gondolini, P. Schiavi, F. Pogliacomi, F. Ceccarelli, T. Antonetti, and M. Zasa, “Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders,” Clinical Journal of Sport Medicine 29, no. 6 (2019): 476–481.
|
| [16] |
J. Ruyer, V. Rutka, J. Garret, C. Rizzo, and V. Guigal, “Endoscopic Fasciotomy for Chronic Exertional Compartment Syndrome of the Forearm: Clinical Results of a New Technique Using an Endoscopic Carpal Tunnel Release Device,” Hand Surgery and Rehabilitation 39, no. 3 (2020): 154–158.
|
| [17] |
J. B. Facon, N. Mainard, P. Louis, P. A. Faure, and J. M. Cognet, “Ultrasound-Guided Fasciotomy in Forearm Chronic Exertional Compartment Syndrome: Preliminary Results in 12 Cases,” Hand Surgery and Rehabilitation 43, no. 3 (2024): 101719.
|
| [18] |
A. Pozzi, G. Pivato, K. Kask, F. Susini, and L. Pegoli, “Single Portal Endoscopic Treatment for Chronic Exertional Compartment Syndrome of the Forearm,” Techniques in Hand & Upper Extremity Surgery 18, no. 3 (2014): 153–156.
|
| [19] |
F. Smeraglia, F. Tamborini, L. Garutti, A. Minini, M. A. Basso, and M. Cherubino, “Chronic Exertional Compartment Syndrome of the Forearm: A Systematic Review,” EFORT Open Reviews 6, no. 2 (2021): 101–106.
|
| [20] |
Y. Marwan, A. Addar, N. Algarni, N. Algarni, M. Burman, and P. A. Martineau, “Endoscopic Fasciotomy for Chronic Exertional Compartment Syndrome of the Forearm: Systematic Review of Outcomes and Complications,” World Journal of Orthopedics 12, no. 5 (2021): 320–328.
|
| [21] |
E. A. Miller, A. L. Cobb, and T. K. Cobb, “Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique,” Hand (N Y) 12, no. 5 (2017): NP58–NP61.
|
| [22] |
J. M. Cognet, J. B. Facon, A. Faure, and O. Mares, “Chronic Exertional Compartment Syndrome in the Forearm: Ultrasound-Guided Surgical Technique,” Hand Surgery and Rehabilitation 44S (2025): 102094.
|
| [23] |
P. S. Chan, D. R. Steinberg, M. D. Pepe, and P. K. Beredjiklian, “The Significance of the Three Volar Spaces in Forearm Compartment Syndrome: A Clinical and Cadaveric Correlation,” Journal of Hand Surgery 23, no. 6 (1998): 1077–1081.
|
RIGHTS & PERMISSIONS
2025 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.
PDF
