Double jeopardy: two episodes of forearm compartment syndrome in the same patient.

A 55-year-old woman taking warfarin for previous deep venous thrombosis (DVT), presented with an acutely swollen and painful forearm after forcefully contracting her forearm flexor compartment while using a car hand brake and later, an axe. Compartment syndrome was diagnosed and emergency fasciotomy performed, with a haematoma discovered between the flexor compartments of flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP). After evacuation and resolution of symptoms, the wounds were closed 4 days later. Following discharge on the fifth day, symptoms recurred without warning, prompting re-exploration and discovery of further haematoma. Symptoms again resolved and in due course a skin graft was applied to close the wound without tension.

Multiple schwannomas of the upper limb related exclusively to the ulnar nerve in a patient with segmental schwannomatosis.

Schwannomas are benign encapsulated tumours arising from the sheaths of peripheral nerves. They present as slowly enlarging solitary lumps, which may cause neurological defects. Multiple lesions are rare, but occur in patients with neurofibromatosis type 2 or schwannomatosis. Positive outcomes have been reported for surgical excision in solitary schwannomas. However, the role of surgery in patients with multiple lesions is less clear. The risk of complications such as iatrogenic nerve injury and the high likelihood of disease recurrence mean that surgical intervention should be limited to the prevention of progressive neurological deficit. We report a case of a 45 year old male who presented with multiple enlarging masses in the upper limb and sensory deficit in the distribution of the ulnar nerve. The tumours were found to be related exclusively to the ulnar nerve during surgical exploration and excision, a rare phenomenon. The masses were diagnosed as schwannomas following histopathological analysis, allowing our patient to be diagnosed with the rare entity segmental schwannomatosis. One year post-operatively motor function was normal, but intermittent numbness still occurred. Two further asymptomatic schwannomas developed subsequently and were managed conservatively.