Acute Compartment Syndrome of the Arm after Minor Trauma in a Patient with Optimal Range of Oral Anticoagulant Therapy: A Case Report

Compartment syndrome of the arm is a rare event that can be subsequent to trauma or other pathological and physical conditions. At the arm the thin and elastic fascia may allow accumulation of blood more than in other districts, especially in patients undergoing anticoagulant therapy. We describe a rare case of an acute compartment syndrome of the arm after minor trauma with partial biceps brachii rupture in a patient with warfarin therapy and optimal value of INR. Prompt diagnosis and surgical decompression helped to avoid the occurrence of complications with a satisfying recovery of arm function. 1. Introduction Compartment syndrome of the arm is rare. In most cases, it occurs after trauma [1, 2], biceps or triceps rupture [3], subatmospheric pressure exposition [4], tourniquets application [5], shoulder dislocation [6], surgical complication [7], blood pressure cuff malpositions [8], injections [9], and venipunctures [10, 11]. Arm fascia is relatively thinner and more elastic compared to other anatomical districts. This creates more space for accumulation of blood. Variability of tolerance to increased intracompartmental pressure may influence clinical onset and the course of the syndrome [12, 13]. Patients undergoing anticoagulant therapy raise their susceptibility to haemorrhage, and sometimes these drugs can facilitate the onset of an acute compartment syndrome. The relationship between acute compartment syndrome and warfarin treatment was first described by Hay et al. in 1992 in seven patients who sustained minor trauma in lower limbs (six cases) and forearm (one case) [14]. In this report, we describe a case of acute compartment syndrome of the arm after minor trauma with partial rupture of short head of biceps brachii in a patient undergoing warfarin therapy. To our knowledge this is the first case reported in the literature in which such kind of syndrome occurred in a patient with optimal value of INR. 2. Case Report A 66-year-old right hand dominant woman reported minor shoulder trauma with arm elongation. She was assuming warfarin for 15 years after aortic valve replacement. At the time of hospital admission, she presented with pain and swelling at the right arm. A wide hematoma was present from the axillary region to the anteromedial side of the arm and the patient complained of limitation and pain of right upper arm during movements without vascular and nervous impairments. Laboratory values revealed increased levels of WBC ( ), Hb 13.2？g/dL, APTT 75.8？sec, LDH 735？UI/L, CK 103？UI/L, and INR of 3.0. Radiographs did not show fractures or