Abstract
CASE HISTORY: 18-year-old nationally ranked runner with childhood-onset, exertional bilateral forearm heaviness/weakness (“lactate-like burn,” intermittent numbness) worsening over 2–3 years and limiting performance. Symptoms are reproducible with high-intensity running/races, occur earlier with shorter/faster events (~500 m into 800 m; ~1 mile into 2-mile), and resolve within 10–15 min of rest; steady long runs may be tolerated. Prior PT (~6 months) and dry needling were ineffective; compression sleeves worsened symptoms. PHYSICAL EXAM: Between episodes: no swelling/tenderness; full, pain-free wrist/elbow ROM; 5/5 strength incl. grip; intact sensation/reflexes; symmetric 2+ radial pulses/capillary refill. DIFFERENTIAL DIAGNOSES: Thoracic outlet syndrome; cervical radiculopathy; peripheral nerve entrapment; upper-extremity chronic exertional compartment syndrome. TESTS & RESULTS: C-spine radiographs normal; cervical/thoracic MRI unremarkable. Provocative running reproduced symptoms with altered arm cadence. Post-exercise pressures elevated in the mobile wad bilaterally (1-min: 35 mmHg R, 38 mmHg L) with lower volar/dorsal values. After local lidocaine prior to testing, he developed brief transient altered mental status suspicious for mild systemic toxicity; resolved with rest/hydration. FINAL DIAGNOSIS: Bilateral upper-extremity chronic exertional compartment syndrome, mobile wad predominant. DISCUSSION: Upper-extremity chronic exertional compartment syndrome is uncommon and may mimic neurovascular pathology; reproducible exertional symptoms with rapid recovery plus elevated post-exercise pressures supported diagnosis and definitive management. OUTCOME OF THE CASE: Bilateral forearm fasciotomies under general anesthesia without complications. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Incisions healed; ROM restored; graded return to running. At follow-up (~4 months), complete symptom resolution with unrestricted running and weight training. Lidocaine recorded as adverse reaction/allergy precaution; follow-up PRN.
Recommended Citation
Utter, Taylor; Chu, Justin; McGinnis, Nate; and Stamatis, Andreas
(2026)
"Bilateral Upper-Extremity Chronic Exertional Compartment Syndrome — Running,"
International Journal of Exercise Science: Conference Proceedings: Vol. 15:
Iss.
8, Article 29.
Available at:
https://digitalcommons.wku.edu/ijesab/vol15/iss8/29