[StuM]

Does anyone have any experience or knowledge of chronic compartment syndrome (CCS) in the forearm?

I started having problems earlier this year when bouldering indoors. The first couple of times it came up I had done what I would usually have considered a good warm up only for my left arm to be totally pumped and my right fine. The left forearm would stay tight and sore for a couple of days after a session. I spoke to a few people about it but never saw any specialists (with hindsight I probably should have!).

In May I broke my hand in a fall at Cheedale. I presumed that the rest required to get my hand mended (about 2 months) would be enough to let my arm fix itself. after 8 weeks I did some routes at the wall and realised nothing had changed.

Since then I've seen a physio who noticed some minor swelling and loss of definition on the inside of my forearm, we tried some stretching and acupuncture which had little effect. He then suggested that it could be chronic compartment syndrome, though he didn't have experience with it in the forearm (it is most common in the lower leg). This week I saw an upper limb specialist (consultant surgeon) who agreed that it is likely to be compartment syndrome and is arranging a intracompartmental pressure test to diagnose it. If it is positive then surgery to release the compartment appears to be the only option if I want to keep climbing (which I do).

In the mean time I have changed my climbing from mainly bouldering and redpointing to low intensity high volume routes. A typical session at the wall will be 10-15 juggy 5s and 6as including a long warm up and warm down, I try to avoid getting pumped at all. The physio and specialist think this is a good idea and if anything my arm actually feels better because of it.

I've done a fair bit of research into this but I've not come across any other climbers who have the condition. I'd be really interested to hear from anyone (by reply or email) who knows about the condition in climbers and can pass on any advise.

Cheers,

Stu

[GCW]

I've only seen a few cases, none were in climbers.  Sorry.

[fatdoc]

certainly an uncommon disease, bit off my radar....

one thought is an accessory 1st rib, causing inhibition of venous drainage to the upper limb

what do think GCW?

[GCW]

I think accessory ribs are blamed for far too much, and in the majority of cases sit there benignly.

As for chronic compartment syndrome (the name may not be accurate, but that's by the by) there's various theories, but it isn't clear what the exact cause is.  It is true that it requires an increase in the intracompartmental pressure to the degree where perfusion is compromised, resulting in pain.  Initially compartment pressure exceeds venous pressure, inhiniting drainage and causing oedema.  If the intracompartmental pressure continues to be high, eventually reduced areteriolar supply can give localised (but reversible) ischaemia and pain.

Pre and post exercise compartment pressures are diagnostic in many cases.  I usually did them in clinic and you get a quick result.  If the diagnosis is made, and you want to continue climbing things that aggravate symptoms, a limited fasciotomy may be an option. 

Out of interest Stu, which compartments do you get symptoms in?

[StuM]

As for chronic compartment syndrome (the name may not be accurate, but that's by the by) there's various theories, but it isn't clear what the exact cause is.  It is true that it requires an increase in the intracompartmental pressure to the degree where perfusion is compromised, resulting in pain.  Initially compartment pressure exceeds venous pressure, inhiniting drainage and causing oedema.  If the intracompartmental pressure continues to be high, eventually reduced areteriolar supply can give localised (but reversible) ischaemia and pain.

From the people I have spoken to and from research that sounds about right.

I'm seeing the specialist again (probably in October) to get a the diagnostic test and discuss surgical options based on the results. I believe the problem is limited to the flexor compartment, thats my opinion and I'm not an expert by any means.

I really appreciate the help and feedback. Will report back when I know more!

[GCW]

It is possible to get symptoms from the deep compartment (FDP) alone, from superficial compartment alone (mostly DFS, FCU, FCR) or both.  The compartment pressures don't always tell the difference, although in the long run it doesn't make a massive differenceto surgical intervential.

It sounds like you've had a decent look at the subject.  If you have a decent upper limb orthopod you'll be fine.

[coolboy]

Any news Stu?

Just noticed this thread, I've had problems kinda similar too, had problems for about 18months, my flexors in right forearm keep on getting pumped really quickly and haven't got better. Initally I found my left arm seemed much stronger than left which wasn't normal and was getting pumped very quickly, I rested and stuck to easy routes for a couple of months but the problem has continued. Things are worse after the wall and I'm generally ok outside. Throwing things and moving ?brachioradialis seem to set things off.

I did wonder about compartment syndrome too but couldn't find much on it and have tried to ignore the problem but thinking now I might do better being a bit more proactive.

Any thoughts GC? There's a sports physio who works a few doors down so I've no excuses or try to see orthopod?

cheers

tom

[coolboy]

Before getting shot down, it's an problem with my extensor compartment with pain laterally over brachioradialis side.

Cheers