CASE REPORT A. Mofidi Æ R. Sankar Æ J.P. McCabe Compartment syndrome of the shoulder girdle CASE REPORT Received: 17 December 2001 / Accepted: 22 April 2002 / Published online: 3 July 2002 Ó Springer-Verlag 2002 Abstract We report a case of subacute compartment syndrome involving the deltoid muscle of a young per- son. We discuss the presentation, predisposing factors, investigation and treatment of this otherwise rare con- dition. Keywords Compartment syndrome Æ Shoulder Æ Deltoid Syndrome des loges de la ceinture scapulaire Re´sume´ Nous rapportons un cas de syndrome des loges chronique du deltoı¨de chez un sujet jeune. Nous dis- cuterons de la pre´sentation, des facteurs pre´disposants ainsi que de l’exploration et du traitement de cette af- fection par ailleurs rare. Mots-cle´s Syndrome compartimental Æ E ´ paule Æ Deltoı¨de Case presentation A 29-year-old man presented to an orthopaedic surgeon complaining of a history of severe left-sided shoulder pain for 1 month. The pain was of gradual onset and involved the left shoulder and deltoid region. It was severe, aggravated by movement and required a signifi- cant amount of opiate analgesia for relief. The patient was an amateur athlete and an expert in martial arts who recently underwent the process of gender reassignment, changing from female to male. He was on 120 mg/day of testosterone undecanoate for this reason. One year previously he had subacromial decompression of the right shoulder for rotator cuff impingement, following which he had symptomatic relief. On admission for this latter episode, he was investigated with plain radiogra- phy followed by magnetic resonance imaging (MRI) of the left shoulder (Fig. 1). The plain film was normal and the MRI showed mild inflammation involving the del- toid muscle. He was treated with rest and non-steroidal anti-inflammatory medication and commenced on range of movement exercises. On the fifth day of admission, his shoulder and the deltoid region became swollen, un- bearably painful and erythematous. He had measure- ment of pressures of anterior and posterior deltoid muscle compartments using portable tissue pressure monitor (Stryker Instruments, Kalamazoo, MI, USA) and was found to be 45 mmHg. The left deltoid muscle was decompressed under general anaesthesia through a longitudinal incision ex- tending from just below the acromion process down to the insertion of the deltoid muscle. The incision showed tense deltoid fascia covering a severely inflamed, partly necrotic deltoid muscle (Fig. 2). This was confirmed after exposing the anterior, middle and posterior deltoid muscles. The deltoid muscle was debrided to remove all necrotic tissue. The remaining muscle was healthy and contractile. The wound was covered by primary inten- tion. The left deltoid muscle was re-explored surgically through the same incision a week later and was found to have fully recovered after the initial decompression. The patient was commenced on rest in a sling followed by mobilisation after 5 weeks. He returned to full shoulder activity 3 months post decompression. Discussion Compartment syndrome is defined as an increase in the hydrostatic pressure in a closed circular space of compartment resulting in decreased perfusion of Eur J Orthop Surg Traumatol (2002) 12: 99–101 DOI 10.1007/s00590-002-0028-3 A. Mofidi Æ R. Sankar Æ J.P. McCabe Department of Orthopaedic Surgery, Merlin Park Regional Hospital, Galway, County Galway, Republic of Ireland R. Sankar (&) 45 Tudor Lawn, Newcastle, Galway, County Galway, Republic of Ireland E-mail: harshasankar@yahoo.co.uk Tel.: +353-877980345