Original article
Epidemiology 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

https://doi.org/10.1016/j.hansur.2020.12.017Get rights and content

Abstract

Upper limb chronic exertional compartment syndrome (CECS) has been described in amateur and professional motorcycle racers, but there is no published data about its prevalence. The purpose of this study was to define the awareness, prevention and prevalence of this syndrome in licensed motorcycle racers in competition in France. Secondary purposes were to determine the functional impact of CECS and post-treatment outcomes. The 20,641 licensed racers in competition of the French Motorcycle Federation were sent a self-assessment questionnaire about upper limb pain and CECS physical examination findings, functional impact and treatment outcomes. The satisfaction level was assessed after each type of treatment. Acceptability rate was 6.35% with 1311 racers responding. CECS was unknown by 29% of racers. Prevention methods were unknown by 10% of racers. Less than 50% of racers modified their bikes. The prevalence of upper limb CECS in competitive racers was 9%: 8.7% forearm, 0.2% thenar, 0.1% hypothenar and 0.4% first dorsal interosseus compartments. The prevalence was 16% in international level racers, 11% in national level racers and 7.3% in regional level racers. A quarter of racers were satisfied or very satisfied with the outcomes of conservative therapy and rehabilitation. Only 67 racers underwent surgical treatment for their upper limb CECS: 31 by open fasciotomy, 23 by minimally invasive fasciotomy and 13 by endoscopy-assisted compartment release. In these 67 racers, the mean visual analog score for pain improved significantly (p < 0.001 95% CI [3.1–4.5]) with 81% satisfied or very satisfied with surgery outcomes. This epidemiologic self-assessment questionnaire for upper limb CECS is a new concept. This study screened for CECS and offer information regarding evaluation, treatment, and management.

Résumé

Le syndrome des loges chronique ou d’effort (SLE) des membres supérieurs est décrit chez les pilotes de moto amateurs et professionnels sans aucune publication sur sa prévalence. Nos objectifs étaient d’évaluer l’information, la prévention et la prévalence du syndrome parmi les licenciés en compétition. Les objectifs secondaires étaient d’évaluer le retentissement fonctionnel et le degré de satisfaction des pilotes. Les 20 641 licenciés annuels d’une fédération nationale ont reçu un questionnaire d’auto-évaluation sur les douleurs des membres supérieurs, les signes cliniques du SLE, son retentissement fonctionnel et les traitements entrepris. Une enquête de satisfaction après chaque traitement était réalisée. Le taux de réponse était de 6,35% avec 1311 pilotes. Vingt-neuf pour cent des pilotes ne connaissait pas le SLE et 10% ne connaissaient aucun moyen de prévention. Moins de 50% des pilotes avaient adapté leur équipement. La prévalence du SLE des pilotes était de 8,9% : 8,7% pour le syndrome antébrachial, 0,2% thénarien, 0,1% hypothénarien et 0,4% interosseux postérieur. Elle était de 16% au niveau international, 11% national et 7,3% régional. Un quart des pilotes étaient satisfaits ou très satisfaits par le traitement médicamenteux ou par la rééducation. Seuls 67 pilotes ont été opérés, 31 à ciel ouvert, 23 par voie d’abord mini-open et 13 par endoscopie. Tous les traitements chirurgicaux réalisés apportaient une amélioration significative des résultats sur l’évaluation visuelle analogique de la douleur (p < 0.001 IC 95 [3,1–5]) avec 81% des pilotes satisfaits ou très satisfaits. Ce questionnaire épidémiologique pour les SLE des membres supérieurs est une nouveauté. Il permet de dépister et de renforcer l’information et la prévention de ce syndrome chez les pilotes.

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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