Original articleEpidemiology of upper limb chronic exertional compartment syndrome (CECS) in the French Motorcycle Federation racers: Results of a national questionnaire-based studyEpidémiologie du syndrome des loges d’effort (SLE) des membres supérieurs chez les licenciés de la Fédération Française de Motocyclisme (FFM) : résultats d’un questionnaire national
Introduction
Effort-related chronic compartment syndrome (ERCCS) or chronic exertional compartment syndrome (CECS) is a pathological increase in intramuscular compartment pressure that is effort related [1]. Compared with lower limb CECS, the orthopedic literature on the assessment and treatment of upper limb CECS is sparse. This syndrome remains poorly understood and under-diagnosed [2]. Many publications describe CECS as “arm pump” in motorcyclists [3], mountain bikers [4], race car pilots, wrestlers, rowers, weightlifters, and climbers [5], in amateurs and professionals alike [6]. Diagnosis is determined based on function, case history, and clinical assessment. Motorcycle drivers grip their handlebars firmly during a race, for 18−26 min [7]. Both hands are constantly gripping the handlebars while the clutch (left hand) and the brake (right hand) are applied intermittently. Vibrations transmitted from the front fork and handlebars to the upper limbs provide information on track conditions [7]. During a race, riders suffering from CECS feel a continuous dull ache, swelling, weakness, and paresthesia in the forearms, limiting their endurance capacity [7].
To this day, there have been no publications on the prevalence of upper limb CECS in motorcyclists. It is estimated that 859 000 motorcycles were used in 2017 for track racing and motocross [8]. There were 20 641 French Motorcycle Federation (FFM) registered riders with a racing license in January 2020 [9]. The primary aim of this study was to gather data on knowledge, prevention and prevalence of CECS among licensed FFM riders. The secondary objectives were to evaluate functional impact and patient satisfaction after treatment.
Section snippets
Patients and methods
This national cross-sectional epidemiological survey was carried out in FFM riders with a racing license between December 2019 and February 2020.
Sample characteristics
Among the 20 641 license holders, 1311 answered the questionnaire. Acceptability of the questionnaire was 6.35% (Fig. 1). Our sample was essentially constituted of young males (96% men) with an average 18 (± 12) years of racing; 843 (64%) were regional level, 419 (32%) were national level, and 49 (3.7%) were international level (Table 1).
Information
Of the 1311 riders, 376 (29%) were unaware of CECS. Out of the riders who were aware of it (71%), knew about deltoid (2.4%), forearm (65%), thenar (11%) and
Information and prevention
Overall, motorcycle riders licensed for competition are poorly informed since 29% were not aware of CECS. More than one-quarter of symptomatic riders had consulted at least two health professionals before being diagnosed with CECS. Our sample reported a 2-year period of misdiagnosis between the onset of symptoms and CECS diagnosis.
One driver out of 10 was not aware of a single prevention method. While 90% adapted their riding conditions, less than 50% of riders had modified their equipment. The
Conclusion
The presentation of epidemiological data on CECS in France is a novelty. The 30.14% prevalence is non-negligeable, as well as its impact on function in professional (18%) and daily life activities (22%) for riders. Conservative management is the first treatment option, with over one-third of riders satisfied or very satisfied with outcomes following rehabilitation and medication. The gold standard remains surgery after failure of 3 to 6 months well-conducted conservative treatment (74.6% of
Human and animal rights
The authors declare that the work described has been carried out in accordance with the Declaration of Helsinki of the World Medical Association revised in 2013 for experiments involving humans as well as in accordance with the EU Directive 2010/63/EU for animal experiments.
Informed consent and patient details
The authors declare that this report does not contain any personal information that could lead to the identification of the patient(s) and/or volunteers.
Disclosure of interest
The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper.
Funding
The authors declare that they have no known competing financial or personal relationships that could be viewed as influencing the work reported in this paper.
Author contributions
All authors attest that they meet the current International Committee of Medical Journal Editors (ICMJE) criteria for Authorship.
Conflict of interest
Laurent Obert has no conflicts of interest for this article, but with the following entities: FX Solutions™, Zimmer™, Medartis™, Evolutis™, Wright™, Elsevier™, University of Bourgogne Franche-Comté, University hospital of Besançon.
The other authors have no conflicts of interest to declare.
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