Acute compartment syndrome caused by hematoma after shoulder surgery: a case series

Background: The development of acute compartment syndrome (ACS) of the upper extremity after an elective surgical shoulder procedure is rare but can have devastating results. We describe a series of patients who developed ACS of the upper extremity caused by hematoma formation and subsequent upper extremity swelling after undergoing elective surgical shoulder procedures. Methods: We retrospectively reviewed the database of our tertiary care institution between 2004 and 2019 to find patients who developed ACS after elective shoulder surgery. We found 4 such patients and reviewed their medical records and extracted data on their history, clinical examination, predisposing factors, treatment, and clinical and radiographic outcomes. Results: Of the 4 patients treated, 2 had undergone reverse total shoulder arthroplasty, 1 had undergone open biceps tenodesis, and 1 had undergone closed manipulation for adhesive capsulitis. Two patients developed symptoms of ACS within 24 hours of the index procedure. Both were treated with immediate decompression of the hematoma, and both experienced complete pain relief and full recovery of function at 1-year follow-up. Two patients were on anticoagulation therapy. Of these, 1 patient developed ACS symptoms 14 days after a revision reverse total shoulder arthroplasty and was treated successfully with compartment release. Despite treatment, the other patient developed extensive necrosis of muscles and nerves in the upper extremity and severe neurologic deficits in hand and forearm function. Conclusion: ACS of the upper extremity caused by hematoma formation can lead to catastrophic outcomes if diagnosis and treatment are not immediate. Providers should be aware of ACS and the need for prompt diagnosis and treatment.