Endoscopic decompression for chronic compartment syndrome of the forearm in motocross racers.

PURPOSE: Sporting activities that involve repetitive stress to muscle compartments can elicit chronic exertional compartment syndrome. Its occurrence in the lower leg muscle compartments is most common, but other locations are less well known and the pathophysiology is not completely understood. In motocross racers, chronic exertional compartment syndrome can occur in the muscles of the lower arm. Currently, the only accepted treatment of correctly diagnosed chronic exertional compartment syndrome is surgical release of the fascia, which successfully relieves pain and allows patients to return to full activity. Open decompression is considered as the gold standard of treatment. This clinical paper describes our new endoscopic technique and investigates the functional outcome after surgery. METHODS: We report on a series of 154 chronic exertional compartment syndromes afflicted motocross racers treated with an endoscopic release of the lower arm muscles. An MRI scan before and after strenuous exercise of the hand flexors (repetitive grip until exhaustion for 15 min) was performed to confirm the clinical diagnosis of chronic exertional compartment syndrome. Symptom severity before and after surgery was assessed using a visual analogue scale. RESULTS: Preoperative symptom severity scores were 1.1 ± 0.3 before exercise and 7.4 ± 1.5 after exercise. Post-operatively, these were 1.0 ± 0.2 and 1.7 ± 0.9. The pre- versus post-operative symptom scores after exercise were significantly different (p < 0.0001). No perioperative complications occurred, and at 6 weeks, all of the racers resumed their sportive activities. CONCLUSION: It can be concluded that endoscopic release of the superficial compartment of the forearms of motocross racers diagnosed with chronic exertional compartment syndrome is a valuable treatment option, with mild post-operative pain and fast recovery.

Diagnosis of appendicitis by transvaginal ultrasound examination.

BACKGROUND: Appendicitis is a frequent cause of abdominal pain. Symptoms may be atypical, and the appendix may not be visualised through abdominal ultrasonography. This case report illustrates the important role transvaginal ultrasound examination may have in the diagnostic workup of abdominal pain. METHODS: A case report focussing on imaging through transvaginal ultrasonography and comparing the ultrasonographic findings with CT-scan, as well as macroscopic examination and microscopy. RESULTS: A 33-year-old woman presenting at the emergency department with lower abdominal pain since 1 week. Transvaginal ultrasound shows a typical 'target sign' together with a blind-ending fluid-filled structure posterolateral right of the uterus, suggestive of appendicitis. These findings are confirmed on CT-scan, and a laparoscopic appendectomy is performed. We present the typical ultrasound imaging alongside the correlates on CT-scan as well as on macroscopy and on microscopic examination. CONCLUSION: As gynaecologists, we must maintain a high degree of suspicion for non-gynaecological findings. This case report illustrates the value of transvaginal ultrasound in diagnosing appendicitis.

Chronic exertional compartment syndrome of the forearm in motocross racers: findings on MRI.

INTRODUCTION: The purpose of this prospective study was to demonstrate the findings of MRI in motocross racers with chronic exertional compartment syndrome (CECS) of the forearm. MATERIALS AND METHODS: Racers with proven CECS and without CECS and male individuals not involved in strenuous activities with the forearm were included. Signal intensity (SI) and signal-to-noise ratio (SNR) obtained before and after exercise were compared (D-SNR). RESULTS: Magnetic resonance imaging after exercise showed an increase in SI and SNR in the muscles on T2-WI. The SI increase was obvious in the flexor digitorum superficialis (FDS) and profundus (FDP) in all CECS patients. In addition, a minor SI and SNR increase in the extensor carpi radialis longus (ECRL) was noted. In the non-symptomatic group of motocross racers, there was only a minor increase in SI and the SNR, which was similar in the FDP and ECRL muscles. In the untrained individuals a remarkable increase in the SI and SNR of the FDS/FDP-ECRL was noted. This increased SI and SNR was not present in the majority of non-symptomatic racers. CONCLUSION: Post-exertional MRI produces significant findings in CECS of the forearm. The motocross racers without post-exertional oedema in the FDP/FDS had no CECS.