Two Cases of Thenar Compartment Syndrome from Blunt Trauma

• Published in: The Journal of emergency medicine Vol. 44; no. 1; pp. 85 - 88
• Main Authors: Werman, Howard, MD, Rancour, Stephen, MD, Nelson, Richard, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 2013
• Subjects: Adolescent; Adult; compartment syndrome; Compartment Syndromes - diagnosis; Compartment Syndromes - etiology; Emergency; Finger Phalanges - injuries; Fractures, Bone - diagnostic imaging; Humans; Joint Dislocations - diagnostic imaging; Male; Metacarpal Bones - injuries; metacarpal fracture; Radiography; thenar space; Wounds, Nonpenetrating - complications; thenar space; metacarpal fracture; compartment syndrome
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2011.06.133

Abstract Background Compartment syndrome is a limb-threatening complication associated with extremity trauma. The existence of compartment syndrome involving the thenar space is considered controversial and has not been reported in association with blunt traumatic injury of the hand. Objective We report two cases involving compartment syndrome of the thenar space in association with blunt trauma to the hand. Case Report Patient A was a young man who suffered a fracture/dislocation of the right thumb after a fall. Compartment pressures were measured at 70 mm Hg in the thenar space. The patient underwent successful fasciotomy and K-wire stabilization of the thumb and was ultimately discharged with good function on day 4. Patient B suffered a crush injury of the right hand and presented with diffuse swelling associated with median nerve paresthesia. Radiographs revealed a fracture of the triquetrum and of the base of the third metacarpal bone. The patient underwent multiple fasciotomies of the hand, including a release of the thenar space. He was discharged on day 2 with improving function of his thumb. Conclusion Compartment syndrome of the thenar space may be more common than previously reported. Given the limited time frame after which permanent damage occurs, clinicians should consider measurement of thenar compartment pressures in high-risk injuries.