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Acute compartment syndrome of the upper arm has been rarely reported in the literature. Limb compression, muscle avulsion, prolonged tourniquet use, venipuncture in a hemophiliac patient, severe bleeding secondary to thrombolytic therapy, and even trivial trauma have all been reported as causes.1"9 Physical signs can range from pain on passive motion of the involved extremity to complete neurologic and functional impairment of the entire extremity. Functional impairment secondary to nerve damage and muscle ischemia can be permanent and, as in the case of crush syndrome, life threatening. The etiology, diagnosis, and management of acute compartment syndrome of the upper arm are discussed in addition to the case presented here.
CASE REPORT
A 17-year-old, right hand dominant high school football player presented to the emergency room approximately 8 hours after participating in a football game with a painful, swollen posterior upper arm. Four hours after the game the patient noted a swelling in the posterior aspect of his left upper arm with an associated loss of motion secondary to pain. That evening he was awakened by severe pain in the upper arm aggravated by any attempted flexion and relieved with extension. The patient denied any paresthesias. The pain and swelling were not relieved by application of ice. During the game the patient was wearing shoulder pads, but no arm padding. The patient recalled no specific blow to the arm.
The patient presented with his left elbow held in extension. The arm was markedly swollen posteriorly, extending from the olecranon to the axillary crease. The area was tense to palpation. Active flexion at the elbow was limited to 45°, and the pain was intensified with passive flexion of the elbow, which was limited to 90°. The anterior aspect of his upper arm was soft and non-tender to palpation. His brachial pulse above the elbow and radial and ulnar pulses below the elbow were intact and normal. Motor and sensory examination was intact in the forearm and hand over the radial, median, and ulnar nerve distributions. Radiographs of the humérus and elbow were negative except for soft tissue swelling. Compartment pressures of the posterior compartment of the upper arm were taken via the Whitesides method,10 and were noted to be 50 mm Hg to 55 mm Hg....