Clinical Communications: AdultsSpontaneous Compartment Syndrome of the Upper Arm in a Patient Receiving Anticoagulation Therapy
Introduction
Compartment syndrome is a condition in which elevated pressures within an osseofascial compartment cause vascular compromise, and the consequences often lead to ischemia and possible necrosis. It is most common in the anterior and deep posterior compartments of the leg and the volar compartment of the forearm. However, it can occur anywhere in the body that a compartment is present, including the hand, abdomen, buttock, foot, upper arm, and thigh 1, 2, 3, 4, 5, 6. The most common causes include trauma, arterial injury, limb compression, and burns 6, 7. Case reports of compartment syndrome after minimal trauma to the upper arm have been noted after instrumentation or procedures such as venipuncture, arterial access devices, and prolonged compression from a tourniquet (8).
Spontaneous compartment syndrome (in the absence of any inciting event), although rare, can occur. Most often it is associated with type 1 diabetes mellitus, hypothyroidism, influenza virus-induced myositis, leukemic infiltration, nephrotic syndrome, ruptured aneurysm, ganglion cyst, and anticoagulation 9, 10, 11, 12, 13, 14, 15, 16, 17, 18. Most cases, however, have been localized to the compartments of the lower leg and forearm. A search of the literature revealed no cases of spontaneous upper arm compartment syndrome in the literature within the last 20 years.
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Case Report
A 75-year-old man with a history of congestive heart failure, coronary artery disease with placement of two cardiac stents 2 months prior, hypertension, and atrial fibrillation presented to our Emergency Department (ED) complaining of intense pain, swelling, and ecchymosis of his right upper arm for approximately 36 h. The pain and swelling had progressively gotten worse and now he was unable to move his wrist on the affected arm. He reported no fevers, recent trauma, or instrumentation. He
Discussion
The arm has two relatively large compartments, the anterior or biceps compartment and the posterior or triceps compartment, and the smaller deltoid compartment. Both the anterior and posterior compartments can tolerate relatively large volumes of fluid, thereby limiting the rise in pressure and diminishing the risk of compartment syndrome; however, it can occur 8, 19, 20, 21, 22, 23. The anterior compartment contains the elbow flexor muscles along with the ulnar and median nerves. The posterior
Conclusion
Compartment syndrome results in ischemia and necrosis by impeding vascular flow; initially, venous outflow; and eventually, arterial inflow 3, 6, 7. The normal pressure of a tissue compartment falls between 0 and 8 mm Hg. Clinical findings associated with acute compartment syndrome generally correlate with increases in pressure measurements, with capillary blood flow compromise at pressures around 20 mm Hg, pain between 20 and 30 mm Hg, and ischemia at pressures above 30 mm Hg 4, 7, 25. Muscle
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