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Acute Forearm Compartment Syndrome Following Physical Therapy in a Patient Receiving Anticoagulation Therapy: A Case Report

Year: 2026

Type: article

Abstract: Background: Acute compartment syndrome is a surgical emergency that is most often associated with trauma. Rarely, however, it can develop without major trauma in patients receiving anticoagulation therapy. Methods: A 53-year-old woman receiving warfarin therapy presented with progressive swelling and pain in the left forearm after physical therapy. Computed tomography angiography showed preserved arterial flow. On clinical examination, pain and paralysis were present, whereas pallor and paresthesia were absent. Direct compartment pressure measurements demonstrated markedly elevated pressures in the dorsal and deep volar compartments, measuring 88 mmHg and 110 mmHg, respectively. Emergency fasciotomy was performed approximately 9 h after symptom onset. Results: Intraoperative findings showed hematoma formation and partial muscle necrosis in the deep volar compartment. After surgery, persistent bleeding required repeated hemostatic interventions and blood-product transfusion. Negative-pressure wound therapy was applied, and delayed primary closure was subsequently performed. Anticoagulation therapy was temporarily discontinued and later resumed. The patient recovered without further bleeding, wound complications, or functional impairment and was discharged in stable condition. No complications, including hematoma recurrence or infection, were observed during 6 months of follow-up. Conclusions: This case highlights a temporal association between physical therapy and acute forearm compartment syndrome in a patient receiving anticoagulation therapy. It also emphasizes that preserved peripheral pulses and intact arterial flow do not exclude the diagnosis. Early recognition and prompt surgical intervention remain essential to prevent irreversible tissue damage and optimize outcomes.

Source: Journal of Clinical Medicine

DOI: 10.3390/jcm15135052

Authors: Dong Wan Kim, Heui Ro Na, Seung Hyun Kim, Jun Ho Choi, Jae Ha Hwang, Kwang Seog Kim

Institutions: Chonnam National University, Chonnam National University Hospital

Language: English

Topic: Muscle and Compartmental Disorders

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,137