Acute Compartment Syndrome Of The Upper Arm

摘要

Acute compartment syndrome of lower limb and forearm is quite well-known pathology. However its occurrence in upper arm is very rare and only a few cases have been described in medical literature. We want to share our experience of managing this condition especially in semiconcious or obtunded patient after heavy binge drinking. High suspicion should be considered due to reduced response to pain because of impaired conscious level. Introduction Compartment syndrome occurs when pressure within a closed muscle compartment exceeds the perfusion pressure and results in muscle and nerve ischemia. The report of compartment syndromes of upper arm is conspicuously rare in medical literature 1. The causes in arm are trauma, burns, infection, Fracture neck of Humerus, Triceps avulsion, and steroid use in athletes, thrombolytic therapy and prolonged pressure on the arm during sleep or unconsciousness as a result of alcohol or other drugs 2, 3. We wish to report our experience with an upper arm compartment syndrome. Case Report 54 year old gentleman presented to us with pain and marked swelling in his left upper arm. He was found in semi-conscious state in his house after a heavy binge drinking over night. The past history included the hypertension and depression. The vital signs were normal with GCS of 14/15.There was no other injury. The pulses in left arm were palpable. The active flexion was restricted to 45 degrees and pain intensified on passive flexion which was limited to 90 degrees. Sensory examination was not possible because of conscious level. The compartment pressure in the arm was measured immediately which was 32 mmHg. It was repeated after 1 hour and was raised to 49 mm Hg. The blood showed W.B.C of 27.1, urea 7.3mmol/l, creatinine 323uml/l, K 6.9 meq/l, GGT 58 u/l and creatinine kinase (C.K) of 61000u/l (normal 10-186 u/l).The diagnosis of upper arm compartment syndrome was made. It was also obvious that the patient had rhabdomyolysis resulting into acute renal failure as he became oliguric. The immediate fasciotomy of arm was done extending from axilla arcing over the biceps down to extensor compartment of the arm (Fig 1 and 2).