Supraspinatus and infraspinatus compartment syndrome following scapular fracture

Abstract

Acute compartment syndrome occurs when pressure within a confined fascial space rises to a level impairing microvascular perfusion to surrounding tissues.[1234567] The majority of the reported literature is based on lower extremity compartment syndrome, but any muscle group within an osteofascial compartment has the potential to develop compartment syndrome. We report a case of a 64-year-old male who developed an acute compartment syndrome of both the supraspinatus and infraspinatus after sustaining a severely comminuted scapula fracture. Diagnosis of compartment syndrome was made after intracompartmental pressure measurements of the supraspinatus and infraspinatus revealed pressures within 30 mmHg of the diastolic blood pressure, prompting emergency decompressive fasciotomy. At final follow-up, the examination revealed full shoulder strength with near-full range of motion. There were no signs of sequelae from compartment syndrome at any point. Few case reports describe compartment syndrome of the periscapular fascial compartments. However, these cases were either retrospectively diagnosed[89] or diagnosed via magnetic resonance imaging (MRI) findings and lab values.[910] Surgical management of acute compartment syndrome of the supraspinatus has been reported in only one other case.[10] To our knowledge, we report the only case of a patient with acute compartment syndrome of both the supraspinatus and infraspinatus compartments treated with emergent decompressive fasciotomy. Due to the devastating complications and functional loss of a missed diagnosis of compartment syndrome, a high index of clinical suspicion for developing compartment syndrome must be maintained in every fracture setting, regardless of anatomic location or rarity of reported cases.

Keywords: Supraspinatus; compartment syndrome; infraspinatus; scapula fracture.

Figure 1

Posterior view of left shoulder showing extensive swelling, ecchymosis, and abrasion

Figure 2

(a and b) AP and Lateral plain radiographs of Left shoulder injury demonstrating AC joint widening, acromion base fracture, scapular spine and body fracture

Figure 3

3D reconstruction CT scan of left scapula showing segmental fracture of scapular spine and extensive comminution of scapular body

Figure 4

Intraoperative view after fascial release of the infraspinatus and supraspinatus

Figure 5

Postoperative AP shoulder plain radiograph after scapular spine and AC joint fixation