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Exercise Induced Compartment Syndrome
75 Plays6 hours ago
On this episode of Hand Therapy Academy, Delany joins the conversation with a compelling case of exercise-induced compartment syndrome. Tune in to hear the clinical pearls and strategies she used along the way.
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Transcript
Introduction to Hand Therapy Academy
00:00:06
Miranda Materi
Hello, I'm Miranda.
00:00:07
Delaney Wright
And I'm Delaney and we are Hand Therapy Academy.
00:00:10
Miranda Materi
Well, welcome Delaney. We have Delaney with us today. She has been working in hand therapy for two years now. And she works at one of our clinics that is more neuro-based, but still sees a fair amount of orthopedic conditions. So she's gonna come on and talk about some interesting cases that she's had. And we're just gonna chat about exercise induced compartment syndrome or whatever she wants to call it.
Unique Case: Chronic Exertional Compartment Syndrome
00:00:37
Delaney Wright
Yeah, so actually it's called chronic exertional compartment syndrome, which I had actually never heard of until I came across a patient of mine who was actually diagnosed by a doctor in, I believe it was Florida, um and with chronic exertional compartment syndrome of the first dorsal interossei.
00:00:55
Delaney Wright
um It was very interesting. He came in with super hypertrophied first dorsal interossei bilaterally with the right more affected than the left. It was his dominant hand.
00:01:06
Delaney Wright
and um And I was like, whoa, this is kind of like crazy. I've never even heard of this. I've heard of... like and compartment syndrome, but i was like, whoa, is this a medical emergency? And um obviously it wasn't.
00:01:21
Delaney Wright
But yeah, so it was a very unique case and very cool to see. i think I remember texting you and asking you if you had ever heard of it.
00:01:26
Miranda Materi
how
00:01:31
Miranda Materi
Yeah, and I think I had one patient that had it in ah an extensor compartment and he was doing a lot of playing an instrument. So it would happen at that time. And we just did a lot of biofeedback and muscular reag type stuff. But I think what is interesting or what I want to ask you about is how did the doctor in Florida make that diagnosis?
00:01:52
Delaney Wright
You know, i I actually don't know. i think that the what what I found in my research was that you have to diagnose it by like measuring the intercompartmental pressures.
00:02:03
Delaney Wright
um So I don't know if she ended up doing it that way or how she ended up doing that, but um I'm assuming it was with that. But.
00:02:12
Miranda Materi
Yeah, it's interesting because the cases I've seen have just been based on like a high suspicion of that being the problem.
00:02:19
Delaney Wright
Yeah. And that very well could have been what she did. I didn't ask the patient how she ended up diagnosing that, but, um but yeah.
00:02:28
Miranda Materi
That'll be interesting. Okay, so what did you do for treatment?
Therapy Approaches and Lifestyle Influences
00:02:31
Miranda Materi
and So the doctor that diagnosed referred the patient to hand therapy then?
00:02:35
Delaney Wright
So he, yeah, he received or he didn't receive hand therapy in the state he was diagnosed. He ended up moving to Arizona. um It caused him a lot of pain. He liked to play racket sports as well. So when he was playing those, he um he would have a lot of pain and he kind of like it got to where it was so debilitating that he couldn't do that anymore.
00:02:55
Delaney Wright
And um so we ended up, he ended up seeing, searching out for hand therapists and he saw us and we did, we, he did not want to have surgery. was very like adamant that he didn't want to have surgical intervention.
00:03:10
Delaney Wright
um ended up doing a lot of biofeedback stuff and that actually really helped him control the pain and like learn how to use his um like first door and first dorsal interossein is like different pinches without aggravating symptoms too much.
00:03:24
Miranda Materi
Without firing that muscle.
00:03:26
Delaney Wright
Yeah, and he still would fire it when we used our biofeedback. We used the M trigger, um and he would still fire it, but the like levels were much, much lower of like muscle like activation.
00:03:39
Miranda Materi
Now that's interesting, isn't it? Because sometimes I feel like when we're doing exercises, people will favor one muscle like stronger than the other. So obviously he was probably it one that would always try to use his first dorsal interossei where maybe other people wouldn't.
00:03:46
Delaney Wright
Yeah.
00:03:53
Delaney Wright
Always, yeah.
00:03:53
Miranda Materi
And then I was kind of curious of what type of occupation he had or if there was anything he did other than racket sports that would irritate it.
00:04:02
Delaney Wright
um Well, actually, he was kind of like in between jobs and just kind of like doing what he like his passions in life. So he actually was doing some comedy stuff, so stuff that he wouldn't wasn't really using his hands, to be honest.
00:04:15
Miranda Materi
Oh, okay.
00:04:15
Delaney Wright
It was mostly the sports that he was complaining about. Yeah. Yeah.
00:04:19
Miranda Materi
Well, I mean, that's the other thing too, right? When people have like these dramatic lifestyle changes or where they may go from like being like sedentary at a desk and then all of a sudden working out a lot or maybe they weren't very active before and then they started picking up racket sports or something, then they may have ah conditions, which I see too.
00:04:36
Delaney Wright
Yeah.
00:04:38
Miranda Materi
Like when I'm playing pickleball, people will come out and they'll be like, oh, my elbow is really hurting, you know, but it's like, well, you haven't exercised in
00:04:45
Delaney Wright
Yeah.
00:04:45
Miranda Materi
you know, however long and now,
00:04:47
Delaney Wright
Yeah. And now you're at it.
00:04:50
Miranda Materi
now you're at it four or five hours a day. That's not healthy.
00:04:54
Delaney Wright
No.
00:04:55
Miranda Materi
Yeah.
00:04:56
Delaney Wright
um Yeah, no, not at all. And then they go from, yeah, literally zero to 100 really fast.
00:05:02
Miranda Materi
Yeah. Yeah,
Exploring Rare Hand Conditions
00:05:03
Miranda Materi
we see that a lot. So I think a lot of times too, like for those patients, even though yes, they can go to the doctor and, and get a diagnosis for a specific thing. But a lot of times it's just like, really, when you're evaluating the patient is really listening to them and, you know, like learning about their lifestyle and what they're doing, right. And seeing what the changes in their lifestyle have been and then like, Oh, okay, well, I think you just, you don't need to slow down. And maybe you don't need to grip the paddle that high, especially if you're new, you don't need to grip the racket or the paddle that hard.
00:05:31
Delaney Wright
Yes, exactly.
00:05:33
Miranda Materi
Yeah.
00:05:33
Delaney Wright
um I did have another patient of mine who he came to me with very similar symptoms. It was just like in his thenar eminence. And he was actually a doctor in the yeah ER. And he ah his like every time that he like he was like typing around his laptop, his thenar eminence bilaterally, but more so I think it was in his dominant hand would swell up kind of same thing. And I was like, Oh, this is just like my other patient. Um, but we kinda, I, he just wanted to see like what I thought. And he actually was in concurrence. He said he had heard of that.
00:06:07
Delaney Wright
Um, I just kind of brought it up. I was like, you know, there's this thing that's really rare, especially in like the hands. It's more so common in like the lower extremities, but, um, he had actually heard of it in his own research. And he was like, you know, I think I'm going to seek out treatment and a medical diagnosis from like an MD.
00:06:23
Delaney Wright
um But we emailed back and forth after that initial evaluation. And then I didn't hear back from him if he ever got that diagnosis. So yeah.
00:06:30
Miranda Materi
Interesting. I know. And then you wonder, should you like immobilize that area while the inflammation goes down, you know, and then, yeah, I mean, that's probably what I would be like, depending on how bad their pain is, I'd probably be inclined to have it rest and then get some of the inflammation down and then gradually work into some of those tasks that they're doing again.
00:06:36
Delaney Wright
Right. Yeah.
00:06:44
Delaney Wright
the
00:06:49
Delaney Wright
Yeah, that's true. And I didn't try that, but it very well could have worked. I only saw them the one time, unfortunately.
00:06:56
Miranda Materi
Yeah, yeah. No, that's hard when it totally, especially when you're trying to figure out what's going on. And if they're coming to you for your, your thoughts when they don't have a diagnosis already, then you're like, I need to look some stuff up.
00:07:05
Delaney Wright
Yeah.
00:07:08
Delaney Wright
yeah
00:07:09
Miranda Materi
Yeah.
Conclusion and Call to Action
00:07:10
Miranda Materi
I think that's like the fun thing about hand therapy too, is there's always something new to learn.
00:07:14
Delaney Wright
always learning every single day, every time you come into the clinic.
00:07:15
Miranda Materi
Yeah.
00:07:18
Miranda Materi
Every day. ah And I feel that after even being in for 20 years, you know, so.
00:07:23
Delaney Wright
Yeah, I could see that for sure.
00:07:24
Miranda Materi
like
00:07:27
Miranda Materi
All right, well, thank you for sharing your case. And if you're interested or if anyone is interested in learning more or sharing their cases with us, please email us info at hamtherapyacademy or reach out to us on um Instagram at hamtherapyacademy.
00:07:43
Delaney Wright
Thanks for having me.