Chronic Exertional Compartment Syndrome of Forearm Flexor Muscles in Rock Climbers — Evaluation of Physiological Standard Pressures

Abstract

Chronic exertional compartment syndromes (CECS) are a well-known topic in sports medicine. Most commonly affected is the tibialis anterior compartment in runners and walkers. Diagnostic and therapeutic criteria for this group are widely discussed. Only a few cases of CECS of the forearm flexor muscles have been reported, although an increasing number of patients with suspected CECS have been seen by the authors. The objective of this study was to determine pressure levels inside the deep flexor compartment of the forearms during a sports specific stress test, 10 healthy high level climbers were enrolled in a prospective study. All climbers underwent climbing specific ergometry, using a rotating climbing wall (step-test, total climbing time 9–15 min). Pressure measurement was performed using a slit catheter, placed in the deep flexor compartment of the forearm. Pressure registration, as well as blood lactate and heart beat rate measurement was done every 3 minutes and during recovery. In all athletes physical exhaustion of the forearms defined the end point of the climbing ergometry. Blood lactate increased in relation to physical stress, reaching an average of 3.48 mmol/l. Compartment pressure was related to physical stress, exceeding 30 mmHg only in 3 individuals. A critical pressure of more than 40 mmHg was never observed. After the test the pressure decreased to normal levels within 3 minutes in 7/10 individuals. The 3 athletes with higher pressure levels (>30 mmHg) required a longer time for recovery. For further clinical and therapeutic consequences an algorithm was derived. Basic pressure below 15 mmHg and stress pressure below 30 mmHg as well as pressures during the 15-minute recovery period below 15 mmHg are physiological. Pressures of 15–30 mmHg during recovery suggest high risk for CECS, above 30 mmHg prove CECS.