Chronic exertional compartment syndrome of the forearm: a systematic review

in EFORT Open Reviews
Authors:
Francesco SmeragliaDepartment of Public Health, Division of Orthopaedic Surgery, ‘Federico II’ University, Naples, Italy

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Federico TamboriniDepartment of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy

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Leonardo GaruttiDepartment of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy

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Andrea MininiDepartment of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy

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Morena A. BassoDepartment of Public Health, Division of Orthopaedic Surgery, ‘Federico II’ University, Naples, Italy

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Mario CherubinoDepartment of Biotechnology and Life Sciences, Division of Plastic and Reconstructive Surgery, University of Insubria, Varese, Italy

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Francesco Smeraglia, Department of Orthopaedic Surgery, ‘Federico II’ University, Via S. Pansini 5, bd. 12, 80131, Napoli, Italy. Email: francesco.smeraglia@gmail.com
Open access

  • The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm.

  • We searched Medline (PubMed), Web of Science, Embase and Scopus databases on 8 July 2020. Twelve studies were included in this review.

  • We assessed the quality of the studies using the Coleman Methodological Score.

  • Data on demographic features, operative readings, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to sport activity, and outcome measures were recorded.

  • In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications.

Cite this article: EFORT Open Rev 2021;6:101-106. DOI: 10.1302/2058-5241.6.200107

Abstract

  • The aim of this systematic review is to understand which surgical procedure provides better results in terms of pain relief and function in the treatment of chronic exertional compartment syndrome (CECS) of the forearm.

  • We searched Medline (PubMed), Web of Science, Embase and Scopus databases on 8 July 2020. Twelve studies were included in this review.

  • We assessed the quality of the studies using the Coleman Methodological Score.

  • Data on demographic features, operative readings, diagnostic methods, follow-up periods, type and rates of complications, survivorship of the procedure, return to sport activity, and outcome measures were recorded.

  • In conclusion, compared to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications.

Cite this article: EFORT Open Rev 2021;6:101-106. DOI: 10.1302/2058-5241.6.200107

Introduction

The aetiology of chronic exertional compartment syndrome (CECS) remains debated. Today, the most accredited theory reports that a non-compliant fascia stiffens the compartment that fails to adapt to increased blood flow and muscle volume during exercise. 1 CECS of the lower limb is well reported; 2 whereas CECS of the forearm is a rare condition in the general population, but can be observed in motorcycling racers, climbers, and rowers. 3

Clinically, the symptomatology is characterized by forearm pain, stiffness, decreased muscle strength, and paraesthesias. Symptoms disappear when the exercise is stopped. CECS has been described to occur bilaterally in 70% to 100% of patients. 3 Conservative treatment is effective but mainly consists of suspending the trigger activity, which is generally rejected by patients. 2

Four compartments are usually described in the forearm: superficial volar compartment, deep volar compartment, lateral compartment, and dorsal compartment. 4 Open fasciotomy has been considered the gold standard for its ability to release all the compartments. However, the invasive nature of open procedures affects high-level athletes with lengthy periods away from competition. It is for this reason that mini-open techniques were proposed to allow for faster recovery and reduce secondary scar formation. More recently, endoscopic techniques have been proposed by different authors, 5 which guarantee continuous visual control during the surgical procedure.

This is a comprehensive review of studies published on the management of patients with CECS, which aims to investigate which surgical techniques provide better outcomes, with fewer serious or major side effects and faster return to sport.

Methods

A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). 6 The combination of keywords “compartment chronic forearm” OR “exertional compartment forearm” OR “exertional forearm” were used for the search, with no limits for year of publication. Medline (PubMed), Web of Science, Embase and Scopus were accessed on 8 July 2020, and articles in English were identified. All prospective or retrospective clinical studies reporting data of patients affected by chronic exertional compartment syndrome were considered. Only studies published in a peer-reviewed fashion were eligible. Biomechanical studies, studies on animals or cadavers, technical notes, letters to the editor, reviews, and instructional courses were excluded. Two authors independently assessed the abstract of each publication. When the study could not be included or excluded based on the abstract, a full-text version of the article was downloaded. If the full text was not available, the article was excluded from the study. In addition, the reference list of each selected article was searched manually to identify any additional studies missed during the electronic search.

The two investigators assessed each study according to the Coleman Methodological Score (CMS); a score ranging from 0 to 100. 7 Both investigators performed the CMS assessment twice, with an interval of 10 days, and they discussed the scores until consensus was reached when more than a two-point difference was present. Data on demographic features, surgical procedures, diagnostic methods, follow-up periods, type and rates of complications, return to sport, recurrence, and outcome measures were recorded.

Results

A total of 299 studies were identified after the first search. Thereafter, 87 studies were selected on the basis of the abstract, 75 were excluded after the full text had been read, and 12 publications relevant to the topic were included (Fig. 1). All included studies were published between 2005 and 2020. The total number of patients was 336: 98.5% (331) were male and 1.5% (5) female. The total number of forearms treated was 605, with 80% of patients (269/336) receiving a bilateral fasciotomy (Table 1). The mean age of the patients at the time of treatment was 25.1 years (range 16.8–34.0 years), one study did not report data on age, 8 and the mean follow-up time was 56.7 months (range 3.0–97.2 months).

Fig. 1
Fig. 1

PRISMA flowchart. A total of 299 studies were identified at the first search and 87 studies were selected based on the abstract. Finally, 12 articles were included in our systematic review.

Citation: EFORT Open Reviews 6, 2; 10.1302/2058-5241.6.200107

Table 1.

Characteristics, surgical techniques and quality of the studies

Study N of patients Surgical technique N of compartments treated Follow-up (m) Sport activity Coleman Methodological Score
Zandi 2005 10 6 Open 1 patient 2 compartments

5 patients 1 compartment
60 1 wheelchair sprinter

1 motorcycle rider

1 manual worker

1 mountain climber

2 water-skiers
39
Croutzet 2009 17 8 Mini-open 8 patients 4 compartments 27 motorcycle rider 60
Brown 2011 12 Open 6 patients 3 compartments

5 patients 2 compartments

1 patient 1 compartment
97 5 motorcycle rider

1 crane driver/golf,

1 manual worker/martial art

1 martial art/box

2 manual worker

2 rowers
45
Winkes 2012 12 24 Open 24 patients 1 compartments 60 motorcycle rider 46
García-Mata 2013 9 5 Open 2 patients 2 compartments

3 patients 2 compartments
72 motorcycle rider 45
Harrison 2013 8 6 Open 6 patients 4 compartments 3 Rowers 51
Barrera-Ochoa 2016 34 Open

vs.

mini-open
34 patients 4 compartments 46

43
motorcycle rider

motorcycle rider
74
Jans 2015 154 Endoscopic 154 patients 1 compartment 6 motorcycle rider 64
Pegoli 2016 3 Endoscopic 3 patients 1 compartment 46 motorcycle rider 45
Gondolini 2019 54 Mini-open 54 patients 3 compartments 70 motorcycle rider 70
Schiavi 2020 9 Mini-open 9 patients 3 compartments 92 motorcycle rider 63
Ruyer 2020 16 21 Endoscopic 20 forearms 1 compartment

16 forearms 2 compartment
59 17 motorcycle

2 quad racing

1 mountain biking

1 water skiing
62

Quality assessment

All the Coleman scores are given in Table 1. A score of > 85 is considered excellent, 70 to 84 is good, 50–69 is moderate, and < 50 is poor. The mean CMS was 55.3 (range 39.0–74.0).

Diagnosis

The diagnosis was clinical in all the studies. Intra-compartment pressure was measured in ten studies. 3,816 Magnetic resonance imaging (MRI) was performed in three studies. 5,14,15

Surgical techniques

Five studies 812 involved an open fasciotomy. Three studies 14,15,17 involved a mini-open fasciotomy. An endoscopic fasciotomy was performed in three studies. 5,13,16 One study 3 compared two techniques: open vs. mini-open. The number of compartments released in each study is indicated in Table 1.

Outcomes

Patient satisfaction was reported in five studies. 3,11,12,16,17 Pain relief (visual analogue scale [VAS] score) was reported in six studies. 3,5,1215 Functional scale (the Disabilities of the Arm, Shoulder and Hand (DASH) and QuickDASH) were reported in four studies. 3,1315 Outcomes are reported in Table 2.

Table 2.

Subjective outcomes

Study Satisfaction Pre-op VAS Post-op VAS Pre-op DASH/QuickDASH Post-op DASH/QuickDASH
Zandi 2005 10

Open
N\A N\A N\A N\A N\A
Croutzet 2009 17

Mini-open
100% satisfied N\A N\A N\A N\A
Brown 2011

Open
11/12 very satisfied N\A N\A N\A N\A
Winkes 2012 12

Open
83% very satisfied

12% fairly satisfied

5% not satisfied
5.3 0.7 N\A N\A
García-Mata 2013 9

Open
N\A N\A N\A N\A N\A
Harrison 2013 8

Open
N\A N\A N\A N\A N\A
Barrera-Ochoa 2016

Open

vs.

mini-open
32/34 patients very satisfied

2 fairly satisfied (1 MOF, 1 OF)

1 non satisfied (MOF)
7.8

7.8
1.5

1.7
84

86
15

12
Jans 2015

Endoscopic
N\A 7.4 1.7 N\A N\A
Pegoli 2016

Endoscopic
N\A 4.5 0.7 21.7 5.4
Gondolini 2019

Mini-open
N\A 6.8 2.4 84 12
Schiavi 2020

Mini-open
N\A 6.9 2.6 79 17
Ruyer 2020 16

Endoscopic
78% very satisfied

17% satisfied

1% moderately satisfied
N\A N\A 23 1

Note. Visual Analogue Scale (VAS) ; the Disabilities of the Arm, Shoulder and Hand (DASH); mini-open fasciotomy (MOF); open fasciotomy (OF) .

Return to sports

Return to sport is reported in Table 3. The average time before return to sport for open, mini-open and endoscopic fasciotomies was 5.3 weeks, 3.8 weeks and 4.4 weeks, respectively. The overall average time before return to sport was 5 weeks (range 2.7–9.0 weeks).

Table 3.

Number of procedures, complications, revisions and return to sport/work

Study Surgical technique N of patients Complications Revision procedure Return to sport\work (weeks) average
Zandi 2005 10 Open 6 1 haematoma

3 scar problems

None 6
Croutzet 2009 17 Mini-open 8 1 scar problem None 6
Brown 2011 Open 12 1 haematoma

1 recurrence
1 9
Winkes 2012 12 Open 24 none 1 4
García-Mata 2013 9 Open 5 3 scar problems

1 paraesthesia
None 6
Harrison 2013 8 Open 6 1 paraesthesia None 4
Barrera-Ochoa 2016 Open

vs.

mini-open
34 Open:

2 haematomas

1 cutaneous problem

1 superficial infection

Mini-open:

4 haematomas

1 skin problem

2 superficial infections
None

1


Open 3

Mini-open 3
Jans 2015 Endoscopic 154 5 haematomas None 6
Pegoli 2016 Endoscopic 3 none None 3
Gondolini 2019 Mini-open 54 3 scar problem 2 3
Schiavi 2020 Mini-open 9 none None 3
Ruyer 2020 16 Endoscopic 21 2 haematomas

3 hypoesthesia
2 4

Complications

The complications are reported in Table 3. Three studies did not report any complications. 12,13,15

Recurrence

Seven revision procedures were reported. They are displayed in Table 3.

Discussion

The CMS allowed for the detection of several areas with deficiencies. All the studies, except one, 3 were case studies. Ideally, study design would follow a randomized control trial design, but this is difficult to achieve in clinical practice.

Motorcycle racers (93.7%, 315/336) represented the most affected population in this systematic review. This could be attributed to the way these athletes grasp the bike handlebars with continuous bimanual grip.

Clinical assessment remains the gold standard for diagnosis of CECS. Intra-compartment pressure measurement is widely used; 3,816 however, there are differences regarding the timing of measurements: six studies 3,813 measured intra-compartment pressure during exercise or immediately after cessation, while in six studies 3,1014 the pressure was measured from 1 to 5 minutes after exercise. It is interesting that none of the studies measured the intra-compartment pressure after the surgical procedure.

MRI is a valid diagnostic alternative, with the advantage of being less invasive but at the same time more expensive. 18 We believe that MRI can be useful as an alternative for measuring hydrostatic pressure, but it would be redundant to use both methods.

We categorized the surgical fasciotomy techniques into three groups: open, mini-open, and endoscopic. Among these categories there was no uniformity, as indicated in Table 1; in fact the number of compartments released can be variable independently from the technique. Furthermore, there are four studies 911,16 where the number of compartments released changes depending on the surgeon’s clinical judgment.

The reported outcomes revealed that fasciotomy is an effective technique in terms of patient satisfaction, pain relief (VAS) and functional scores (DASH and QuickDASH).

Studies 5,13,16 which involved limited fasciotomy of the superficial volar compartment reported outcomes in terms of satisfaction and remission of symptoms that were at least equal to studies which involved open fasciotomy. For this reason we agree with the hypothesis of Chan et al, 4 that forearm compartments are interconnected and there is a balance of the pressure level, especially through the interosseous membrane.

Haematoma was the most common complication (4.5%, 15/336), with no differences in terms of percentage among the techniques. We can assume that the theoretical advantage of better bleeding control afforded by the open technique compared to the endoscopic does not find credence. When we compared time to return to sport, we noticed that mini-open and endoscopic techniques required a shorter recovery time compared to the open technique. This result was expected because the two techniques are less invasive and require less surgical exposure. Some authors 16,19 report late onset of lateral epicondylitis; they hypothesize that this is due to the remission of CECS which allows the athletes to train at higher intensities.

Our study has several limitations. Firstly, the number of studies included in our review is limited; furthermore, some studies have a small group of patients and there is just one study which compared mini fasciotomy to open fasciotomy. Secondly, fasciotomy was categorized into three groups (open, mini-open, and endoscopic) but there were differences among the studies in terms of compartments released, and these were not categorized. Thirdly, the different methods of assessing and presenting results did not allow for statistical analysis.

Conclusions

In comparison to the other techniques, endoscopic fasciotomy delivers similar success rates and lower incidence of complications. Furthermore, because this procedure is minimally invasive, it has the advantage of a faster return to sport and less impact on cosmetic appearance. Further comparative studies are needed to support these conclusions. In fact we included a small number of studies with limited number of patients.

Open access

This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

ICMJE Conflict of interest statement

The authors declare no conflict of interest relevant to this work.

Funding statement

No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

OA licence text

This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) licence (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed.

References

  • 1.

    Martens MA , Moeyersoons JP . Acute and recurrent effort-related compartment syndrome in sports. Sports Med 1990; 9:6268 .

  • 2.

    Hutchinson MR , Ireland ML . Common compartment syndromes in athletes: treatment and rehabilitation. Sports Med 1994; 17:200208 .

  • 3.

    Barrera-Ochoa S , Haddad S & Correa-Vázquez E 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. Clin J Sport Med 2016; 26:108114 .

    • Search Google Scholar
    • Export Citation
  • 4.

    Chan PS , Steinberg DR , Pepe MD , Beredjiklian PK . The significance of the three volar spaces in forearm compartment syndrome: a clinical and cadaveric correlation. J Hand Surg Am 1998; 23:10771081 .

    • Search Google Scholar
    • Export Citation
  • 5.

    Jans C , Peersman G , Peersman B , Van Den Langenbergh T , Valk J , Richart T . Endoscopic decompression for chronic compartment syndrome of the forearm in motocross racers. Knee Surg Sports Traumatol Arthrosc 2015; 23:25222527 .

    • Search Google Scholar
    • Export Citation
  • 6.

    Liberati A , Altman DG & Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339:b2700 .

    • Search Google Scholar
    • Export Citation
  • 7.

    Coleman BD , Khan KM , Maffulli N , Cook JL , Wark JD ; Victorian Institute of Sport Tendon Study Group. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Scand J Med Sci Sports 2000; 10:211 .

    • Search Google Scholar
    • Export Citation
  • 8.

    Harrison JWK , Thomas P , Aster A , Wilkes G , Hayton MJ . Chronic exertional compartment syndrome of the forearm in elite rowers: a technique for mini-open fasciotomy and a report of six cases. Hand (N Y) 2013; 8:450453 .

    • Search Google Scholar
    • Export Citation
  • 9.

    García-Mata S . Chronic exertional compartment syndrome of the forearm in adolescents. J Pediatr Orthop 2013; 33:832837 .

  • 10.

    Zandi H , Bell S . Results of compartment decompression in chronic forearm compartment syndrome: six case presentations. Br J Sports Med 2005; 39:e35 .

    • Search Google Scholar
    • Export Citation
  • 11.

    Brown JS , Wheeler PC , Boyd KT , Barnes MR , Allen MJ . Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy. J Hand Surg Eur Vol 2011; 36:413419 .

    • Search Google Scholar
    • Export Citation
  • 12.

    Winkes MB , Luiten EJ , van Zoest WJ , Sala HA , Hoogeveen AR , Scheltinga MR . Long-term results of surgical decompression of chronic exertional compartment syndrome of the forearm in motocross racers. Am J Sports Med 2012; 40:452458 .

    • Search Google Scholar
    • Export Citation
  • 13.

    Pegoli L , Pozzi A , Pivato G . Endoscopic single approach forearm fasciotomy for chronic exertional compartment syndrome: long term follow-up. J Hand Surg Asian Pac 2016; 21:812 .

    • Search Google Scholar
    • Export Citation
  • 14.

    Gondolini G , Schiavi P , Pogliacomi F , Ceccarelli F , Antonetti T , Zasa M . Long-term outcome of mini-open surgical decompression for chronic exertional compartment syndrome of the forearm in professional motorcycling riders. Clin J Sport Med 2019; 29:476481 .

    • Search Google Scholar
    • Export Citation
  • 15.

    Schiavi P , Gondolini G , Gandolfi CE , Guardoli L , Vaienti E , Zasa M . Mini-open surgical fasciotomy for chronic exertional compartment syndrome of the forearm in professional motorcycling adolescents. Clin J Sport Med 2020; 30:e225e230 .

    • Search Google Scholar
    • Export Citation
  • 16.

    Ruyer J , Rutka V , Garret J , Rizzo C , Guigal V . Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: clinical results of a new technique using an endoscopic carpal tunnel release device. Hand Surg Rehabil 2020; 39:154158 .

    • Search Google Scholar
    • Export Citation
  • 17.

    Croutzet P , Chassat R , Masmejean EH . Mini-invasive surgery for chronic exertional compartment syndrome of the forearm: a new technique. Tech Hand Up Extrem Surg 2009; 13:137140 .

    • Search Google Scholar
    • Export Citation
  • 18.

    Gielen JL , Peersman B & Peersman G et al. Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI. Skeletal Radiol 2009; 38:11531161 .

    • Search Google Scholar
    • Export Citation
  • 19.

    Fontes D , Clement R , Roure P . [Endoscopic aponeurotomy for chronic exertional compartmental syndrome of the forearm: report of 41 cases]. Chir Main 2003; 22:186196 .

    • Search Google Scholar
    • Export Citation

 

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  • View in gallery
    Fig. 1

    PRISMA flowchart. A total of 299 studies were identified at the first search and 87 studies were selected based on the abstract. Finally, 12 articles were included in our systematic review.

  • 1.

    Martens MA , Moeyersoons JP . Acute and recurrent effort-related compartment syndrome in sports. Sports Med 1990; 9:6268 .

  • 2.

    Hutchinson MR , Ireland ML . Common compartment syndromes in athletes: treatment and rehabilitation. Sports Med 1994; 17:200208 .

  • 3.

    Barrera-Ochoa S , Haddad S & Correa-Vázquez E 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. Clin J Sport Med 2016; 26:108114 .

    • Search Google Scholar
    • Export Citation
  • 4.

    Chan PS , Steinberg DR , Pepe MD , Beredjiklian PK . The significance of the three volar spaces in forearm compartment syndrome: a clinical and cadaveric correlation. J Hand Surg Am 1998; 23:10771081 .

    • Search Google Scholar
    • Export Citation
  • 5.

    Jans C , Peersman G , Peersman B , Van Den Langenbergh T , Valk J , Richart T . Endoscopic decompression for chronic compartment syndrome of the forearm in motocross racers. Knee Surg Sports Traumatol Arthrosc 2015; 23:25222527 .

    • Search Google Scholar
    • Export Citation
  • 6.

    Liberati A , Altman DG & Tetzlaff J et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339:b2700 .

    • Search Google Scholar
    • Export Citation
  • 7.

    Coleman BD , Khan KM , Maffulli N , Cook JL , Wark JD ; Victorian Institute of Sport Tendon Study Group. Studies of surgical outcome after patellar tendinopathy: clinical significance of methodological deficiencies and guidelines for future studies. Scand J Med Sci Sports 2000; 10:211 .

    • Search Google Scholar
    • Export Citation
  • 8.

    Harrison JWK , Thomas P , Aster A , Wilkes G , Hayton MJ . Chronic exertional compartment syndrome of the forearm in elite rowers: a technique for mini-open fasciotomy and a report of six cases. Hand (N Y) 2013; 8:450453 .

    • Search Google Scholar
    • Export Citation
  • 9.

    García-Mata S . Chronic exertional compartment syndrome of the forearm in adolescents. J Pediatr Orthop 2013; 33:832837 .

  • 10.

    Zandi H , Bell S . Results of compartment decompression in chronic forearm compartment syndrome: six case presentations. Br J Sports Med 2005; 39:e35 .

    • Search Google Scholar
    • Export Citation
  • 11.

    Brown JS , Wheeler PC , Boyd KT , Barnes MR , Allen MJ . Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy. J Hand Surg Eur Vol 2011; 36:413419 .

    • Search Google Scholar
    • Export Citation
  • 12.

    Winkes MB , Luiten EJ , van Zoest WJ , Sala HA , Hoogeveen AR , Scheltinga MR . Long-term results of surgical decompression of chronic exertional compartment syndrome of the forearm in motocross racers. Am J Sports Med 2012; 40:452458 .

    • Search Google Scholar
    • Export Citation
  • 13.

    Pegoli L , Pozzi A , Pivato G . Endoscopic single approach forearm fasciotomy for chronic exertional compartment syndrome: long term follow-up. J Hand Surg Asian Pac 2016; 21:812 .

    • Search Google Scholar
    • Export Citation
  • 14.

    Gondolini G , Schiavi P , Pogliacomi F , Ceccarelli F , Antonetti T , Zasa M . Long-term outcome of mini-open surgical decompression for chronic exertional compartment syndrome of the forearm in professional motorcycling riders. Clin J Sport Med 2019; 29:476481 .

    • Search Google Scholar
    • Export Citation
  • 15.

    Schiavi P , Gondolini G , Gandolfi CE , Guardoli L , Vaienti E , Zasa M . Mini-open surgical fasciotomy for chronic exertional compartment syndrome of the forearm in professional motorcycling adolescents. Clin J Sport Med 2020; 30:e225e230 .

    • Search Google Scholar
    • Export Citation
  • 16.

    Ruyer J , Rutka V , Garret J , Rizzo C , Guigal V . Endoscopic fasciotomy for chronic exertional compartment syndrome of the forearm: clinical results of a new technique using an endoscopic carpal tunnel release device. Hand Surg Rehabil 2020; 39:154158 .

    • Search Google Scholar
    • Export Citation
  • 17.

    Croutzet P , Chassat R , Masmejean EH . Mini-invasive surgery for chronic exertional compartment syndrome of the forearm: a new technique. Tech Hand Up Extrem Surg 2009; 13:137140 .

    • Search Google Scholar
    • Export Citation
  • 18.

    Gielen JL , Peersman B & Peersman G et al. Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI. Skeletal Radiol 2009; 38:11531161 .

    • Search Google Scholar
    • Export Citation
  • 19.

    Fontes D , Clement R , Roure P . [Endoscopic aponeurotomy for chronic exertional compartmental syndrome of the forearm: report of 41 cases]. Chir Main 2003; 22:186196 .

    • Search Google Scholar
    • Export Citation