Archives of Orthopaedic and Traumatic Surgery
Arch Orthop Traumat Surg 94, 317-318 (1979)
© J F Bergmann Verlag 1979
Current Problem Case / Der aktuelle Problemfall Chronic Compartmental Syndrome of the Abductor Pollicis Longus and Extensor Pollicis Brevis Muscles Report of a Case Treated with Fasciotomy Ludvig Fjeld Solheim and Rolf Hagen Martina Hansens Hospital, N-1300 Sandvika, Norway
Summary A 32-year-old man with a chronic compartmental syndrome of the muscle bellies of the abductor pollicis longus and the extensor pollicis brevis muscles was successfully treated by fasciotomy of the muscle sheath It is pointed out that this condition was primarily due to hypertrophy of the muscles combined with overuse edema This condition should be differentiated from De Quervain's disease.
The chronic compartmental syndromes due to intensive use of muscles or unaccustomed exercises are now well recognized in the fascial compartments of the leg (Holden, 1973; Kirby, 1970; Leach et al , 1967 ; Patman and Thompson, 1970 ; Reneman, 1975), but less known in the forearm We have treated a similar chronic disabling condition in the fascial compartment of the abductor longus and extensor brevis muscles of the thumb with fasciotomy, giving prompt relief of symptoms.
One year after the onset of symptoms, tenseness and tenderness of the muscle bellies were found, together with pain in the compartment on passive stretching There were no signs of neurological changes or stenosing tenosynovitis. In August 1978 a decompression of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis was performed by a longitudinal incision of the fascial sheath, from the musculotendinous junction to the point at which the bellies disappear proximally into the forearm (Fig 1) As the decompression was carried out the muscles bulged up through the opening They were found to be attached to the overlying fascial sheath by soft edematous adhesions There were no signs of tenosynovitis of the underlying radial wrist extensors After the fasciotomy his symptoms subsided within a few days, and by the 7-month follow-up he had regained normal and symptom-free activity.
Case Report A 32-year-old lawyer developed Reiter's syndrome in 1968, but he had been symptom-free, without treatment, for the last 2 years before admission. In August 1977 during 2 days of unaccustomed and strenuous rowing, the patient noticed pain and swelling in his right forearm During the following year he experienced recurrent pain and swelling localized to the muscle bellies of the long abductor and short extensor muscles of his right thumb upon exertion and even writing Rest, immobilization in a plaster cast, adhesive tapes, physiotherapy, ultrasonics, antiinflammatory drugs and injections of cortisone failed to give relief.
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Fig 1 Dorsal view of the right forearm showing the muscle bellies and tendons of the abductor pollicis longus and extensor pollicis brevis
0344/8444/79/0094/0317/$ 1 00
318
Discussion A compartmental syndrome is defined as a condition in which the circulation and function of the tissues within a closed fascial space are compromised by increased intracompartmental pressure (Matsen, 1975). In the chronic syndrome, recurrent exertional pain disappears after rest (Kirby, 1970 ; Leach et al , 1967 ; Reneman, 1975) This was also a characteristic feature in the clinical history of our patient We believe that this condition was primarily due to hypertrophy of the muscle bellies combined with acute edema in the fascial compartment of the abductor longus and extensor brevis muscles of the thumb. Traumatic tenosynovitis of the radial extensor tendons of the wrist due to compression of the tendons beneath the hypertrophied bellies of the abductor longus and extensor brevis muscles of the thumb has been treated with surgical decompression of the sheath of these overlying muscles (Williams, 1977). The described chronic compartmental syndrome should be differentiated from De Quervain's disease to which it may be related (Finkelstein, 1930 ; Kelly and Jacobsen, 1964) However, if surgically treated, the site of decompression in the first case is the fascial sheath over the swollen hypertrophied bellies of the
L F Solheim and R Hagen: Chronic Compartmental Syndrome
abductor longus and extensor brevis muscles of the thumb, in contrast to the tendon sheath (or sheaths) in De Quervain's disease.
References Finkelstein, H : Stenosing tenosynovitis at the radial styloid J. Bone Jt Surg 12, 509 (1930) Holden, C E A : Traumatic tension ischemia in muscles Injury 5, 223-227 (1973) Kelly, A P , Jacobsen, H S : Hand disability due to tenosynovitis Ind Med Surg 33, 570-574 (1964) Kirby, N G : Exercise ischemia in the fascial compartment of soleus J Bone Jt Surg 52-B, 738-740 (1970) Leach, R E , Hammond, G , Stryker, W : Anterior tibial compartment syndrome J Bone Jt Surg 49-A, 451-461 (1967) Matsen, F A : Compartmental syndrome: An unified concept. Clin Orthop 113, 8-14 (1975) Patman, R D , Thompson, J E : Fasciotomy in peripheral vascular surgery Arch Surg 101, 663-670 (1970) Reneman, R S : The anterior and lateral compartmental syndrome of the leg due to intensive use of the muscles Clin. Orthop 113, 69-80 (1975) Williams, J G P : Surgical management of traumatic non-infective tenosynovitis of the wrist extensors J Bone Jt Surg. 59-B, 408-410 (1977) Received May 4, 1979
Arch Orthop Traumat Surg 94, 317-318 (1979)
© J F Bergmann Verlag 1979
Current Problem Case / Der aktuelle Problemfall Chronic Compartmental Syndrome of the Abductor Pollicis Longus and Extensor Pollicis Brevis Muscles Report of a Case Treated with Fasciotomy Ludvig Fjeld Solheim and Rolf Hagen Martina Hansens Hospital, N-1300 Sandvika, Norway
Summary A 32-year-old man with a chronic compartmental syndrome of the muscle bellies of the abductor pollicis longus and the extensor pollicis brevis muscles was successfully treated by fasciotomy of the muscle sheath It is pointed out that this condition was primarily due to hypertrophy of the muscles combined with overuse edema This condition should be differentiated from De Quervain's disease.
The chronic compartmental syndromes due to intensive use of muscles or unaccustomed exercises are now well recognized in the fascial compartments of the leg (Holden, 1973; Kirby, 1970; Leach et al , 1967 ; Patman and Thompson, 1970 ; Reneman, 1975), but less known in the forearm We have treated a similar chronic disabling condition in the fascial compartment of the abductor longus and extensor brevis muscles of the thumb with fasciotomy, giving prompt relief of symptoms.
One year after the onset of symptoms, tenseness and tenderness of the muscle bellies were found, together with pain in the compartment on passive stretching There were no signs of neurological changes or stenosing tenosynovitis. In August 1978 a decompression of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis was performed by a longitudinal incision of the fascial sheath, from the musculotendinous junction to the point at which the bellies disappear proximally into the forearm (Fig 1) As the decompression was carried out the muscles bulged up through the opening They were found to be attached to the overlying fascial sheath by soft edematous adhesions There were no signs of tenosynovitis of the underlying radial wrist extensors After the fasciotomy his symptoms subsided within a few days, and by the 7-month follow-up he had regained normal and symptom-free activity.
Case Report A 32-year-old lawyer developed Reiter's syndrome in 1968, but he had been symptom-free, without treatment, for the last 2 years before admission. In August 1977 during 2 days of unaccustomed and strenuous rowing, the patient noticed pain and swelling in his right forearm During the following year he experienced recurrent pain and swelling localized to the muscle bellies of the long abductor and short extensor muscles of his right thumb upon exertion and even writing Rest, immobilization in a plaster cast, adhesive tapes, physiotherapy, ultrasonics, antiinflammatory drugs and injections of cortisone failed to give relief.
_
_
_
_ _
_ W A
A i,
_ -_ |
_ _ _
A
_
_
_
Fig 1 Dorsal view of the right forearm showing the muscle bellies and tendons of the abductor pollicis longus and extensor pollicis brevis
0344/8444/79/0094/0317/$ 1 00
318
Discussion A compartmental syndrome is defined as a condition in which the circulation and function of the tissues within a closed fascial space are compromised by increased intracompartmental pressure (Matsen, 1975). In the chronic syndrome, recurrent exertional pain disappears after rest (Kirby, 1970 ; Leach et al , 1967 ; Reneman, 1975) This was also a characteristic feature in the clinical history of our patient We believe that this condition was primarily due to hypertrophy of the muscle bellies combined with acute edema in the fascial compartment of the abductor longus and extensor brevis muscles of the thumb. Traumatic tenosynovitis of the radial extensor tendons of the wrist due to compression of the tendons beneath the hypertrophied bellies of the abductor longus and extensor brevis muscles of the thumb has been treated with surgical decompression of the sheath of these overlying muscles (Williams, 1977). The described chronic compartmental syndrome should be differentiated from De Quervain's disease to which it may be related (Finkelstein, 1930 ; Kelly and Jacobsen, 1964) However, if surgically treated, the site of decompression in the first case is the fascial sheath over the swollen hypertrophied bellies of the
L F Solheim and R Hagen: Chronic Compartmental Syndrome
abductor longus and extensor brevis muscles of the thumb, in contrast to the tendon sheath (or sheaths) in De Quervain's disease.
References Finkelstein, H : Stenosing tenosynovitis at the radial styloid J. Bone Jt Surg 12, 509 (1930) Holden, C E A : Traumatic tension ischemia in muscles Injury 5, 223-227 (1973) Kelly, A P , Jacobsen, H S : Hand disability due to tenosynovitis Ind Med Surg 33, 570-574 (1964) Kirby, N G : Exercise ischemia in the fascial compartment of soleus J Bone Jt Surg 52-B, 738-740 (1970) Leach, R E , Hammond, G , Stryker, W : Anterior tibial compartment syndrome J Bone Jt Surg 49-A, 451-461 (1967) Matsen, F A : Compartmental syndrome: An unified concept. Clin Orthop 113, 8-14 (1975) Patman, R D , Thompson, J E : Fasciotomy in peripheral vascular surgery Arch Surg 101, 663-670 (1970) Reneman, R S : The anterior and lateral compartmental syndrome of the leg due to intensive use of the muscles Clin. Orthop 113, 69-80 (1975) Williams, J G P : Surgical management of traumatic non-infective tenosynovitis of the wrist extensors J Bone Jt Surg. 59-B, 408-410 (1977) Received May 4, 1979
