Disclosures: Mani Singh, MD: No financial relationships or conflicts of interest

Case Diagnosis: An 18-year-old-female rower without prior medical history presenting with few weeks of exertional right forearm pain.

Case Description or Program Description: She reported medial, volar, and dorsal forearm pain that gradually worsened over a few weeks. Symptoms were characterized as a tightness and associated with decreased grip strength. Rowing and lifting exacerbated her symptoms and increased right forearm swelling, whereas rest alleviated her symptoms. She denied numbness and tingling. Review of systems was otherwise negative. Examination of the right forearm illustrated intact radial pulse, normal muscle bulk, and mild tenderness to palpation of the forearm muscles. Physical exam of the elbow and wrist were unremarkable. Neurologic examination, including strength, sensation, and reflexes, was unremarkable.

Setting: Outpatient clinic

Assessment/Results: Magnetic resonance imaging of the forearm, including subcutaneous tissue, muscles, tendons, and osseous structures was unremarkable. Given concerns for chronic exertional compartment syndrome (CECS), compartment pressure testing of the right forearm was performed. Testing illustrated increases in volar pressures (pre-exercise 15 mmHg, post-exercise 25 mmHg), dorsal pressures (pre-exercise 10 mmHg, post-exercise 18 mmHg), and mobile wad compartment pressures (pre-exercise 15 mmHg, post-exercise 19 mmHg). Conservative management, including forearm stretching, instrument-assisted soft tissue mobilization, and activity modification was recommended after confirmation of the diagnosis.

Discussion (relevance): CECS of the forearm is an uncommon cause of intermittent, exertional pain with few cases reported in rowing, motocross, kayaking, and weightlifting athletes. Pathophysiology is suspected to be secondary to repetitive, isometric flexion of the wrist/fingers, as well as the elbow, during the catch, drive, and finish phases of rowing. Diagnosis is based on clinical presentation and pressure testing. In cases refractory to conservative management, surgical fasciotomy may be required.

Conclusions: Forearm CECS in rowing athletes is an uncommon cause of exertional pain secondary to repetitive isometric flexion of the wrist, fingers, and elbow during the initial three phases of rowing.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/exertional-forearm-pain-in-a-female-rower-a-case-report/