Forearm Compartment Syndrome. A serious cause of forearm pain, tightness, and loss of strength during activity

What Is Forearm Compartment Syndrome?

Forearm compartment syndrome is a condition where pressure builds up inside the fascial compartments of the forearm.

Fascia is a strong but flexible tissue that:

• Surrounds muscles

• Connects muscles to bones and skin

• Allows muscles, nerves, and blood vessels to move freely

Thanks to healthy fascia:

• You can move your fingers independently from your wrist

• Blood and nerve signals reach muscles regardless of arm position

• Forces are efficiently transferred through the arm

When the fascia becomes too tight or stiff, it stops tissues from sliding properly. This leads to reduced blood flow, nerve irritation, pain, and rapid muscle fatigue.

What Goes Wrong? (Simple Explanation)

Normally:

• Blood easily flows from tiny capillaries into veins

When pressure inside a fascial compartment rises:

• Blood cannot leave the area properly

• Oxygen-rich blood cannot enter the muscles

• Muscles and nerves become oxygen-deprived

This causes:

• Pain

• Tightness

• Weakness

• Early exhaustion during activity

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Causes of Forearm Compartment Syndrome

Acute (Sudden) Causes

Acute compartment syndrome is a medical emergency and may be caused by:

• Direct trauma or bruising

• Bone fractures

• Repeated attempts to realign a fracture

• Tight stitches or bandages

• Bleeding inside the forearm (hematoma or clot)

• Burns

• Insect or animal bites

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Chronic (Exercise-Induced) Causes

Chronic forearm compartment syndrome develops gradually and is linked to:

• Scar tissue

• Tight or long-term bandaging

• Repetitive overload

It commonly affects:

• Strength athletes

• Kayakers

• Motorcyclists

• Young people with high muscle mass

Interestingly, the condition is less common with age, as muscles and fascia lose stiffness and occupy less space.

Symptoms – What Patients Usually Feel

1. Tight, bursting pain in the forearm during activity, which disappears after stopping

2. Pain and weakness force you to stop, even though you still feel energetic

3. Pain that feels too intense for the injury may suggest an acute form

4. Numbness, tingling, pins-and-needles, or reduced sensation

5. Stretching the forearm makes symptoms worse

6. Visible swelling; skin may become tight, shiny, pale, or later bluish

7. The forearm may feel hard or firm to the touch

8. Weak or absent pulse in the hand

9. The affected arm may feel colder

10. Increased blood pressure

⚠️ Not all symptoms appear in every case, and some occur late.

What Happens If It’s Not Treated?

Untreated forearm compartment syndrome can lead to:

• Permanent nerve damage

• Muscle paralysis

• Ischemic contractures (permanent stiffness)

• Scar tissue formation

• Muscle death (necrosis)

Early diagnosis is critical.

Diagnosis

Acute cases can be difficult to diagnose because symptoms may be masked by injury.

Diagnosis is based on:

• Symptoms

• Medical history

• Physical examination

To confirm the diagnosis, doctors may use:

1. Direct pressure measurement inside the compartment

   • Pressure above 20 mmHg is abnormal

2. EMG (to assess nerve function)

3. Ultrasound (accessible but not very specific)

4. Bone scintigraphy

5. SPECT imaging (very accurate but limited availability)

6. Venography (useful mainly in chronic cases)

   
   

Treatment

Treatment Goals

• Reduce pressure inside the fascial compartments

• Restore blood flow and nerve function

• In chronic cases: reduce symptoms and improve tolerance to activity

  
  

Acute Compartment Syndrome (Emergency)

Treatment may include:

• Removing the source of compression (cast, bandage)

• Fasciotomy (surgical release of the fascia)

• Hyperbaric oxygen therapy to improve tissue oxygenation

After stabilisation, physiotherapy is essential.

⚠️ Ice, compression, and elevating the arm above heart level are not recommended, as they further reduce blood flow.

Physiotherapy Treatment

Physiotherapy focuses on:

• Manual fascial release

• Soft tissue therapy

• Active and passive exercises

• Restoring normal tissue glide

• Improving circulation and movement control

The goal is to allow tissues to slide freely again and tolerate load without pain.

When to See a Physiotherapist or Doctor

You should seek professional help if:

• Forearm pain appears only during activity

• Pain forces you to stop despite good fitness

• Symptoms disappear with rest but return every time

• You feel numbness, tingling, or weakness in the hand

Early treatment can prevent surgery and permanent damage.

References

1. Kirzynka G., Słowiński K. Diagnosis and treatment of acute compartment syndrome. 2013.

2. Szmidt J. Fundamentals of Surgery. Medycyna Praktyczna, 2004.

3. Timothy F. C. Compartment Syndrome. Medycyna Praktyczna, 2005.

4. Brotzman S.B., Wilk K.E. Orthopaedic Rehabilitation. Elsevier, 2009.