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DISABLEMENT MODEL CASE STUDY 

 

57 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 4 – Issue 1 – February 2021 

 
 

Bi-Lateral Hand Compartment Syndrome Secondary to Autoimmune 
Disorder in a Former High School Multi-Sport Athlete  
Alyssa Vaniman, MS, LAT, ATC 
*California State University, Los Angeles, Los Angeles, CA 

  

 
ABSTRACT 
Patient is a 21-year-old female former multiple-sport 
athlete who has suffered from the development of multiple 
cases of compartment syndrome throughout their body. At 
the time the medical staff encountered the patient, they 
were diagnosed with bilateral hand compartment 
syndrome. An autoimmune disorder known as Scleromyositis 
was diagnosed as the source of the multiple diagnosed 
cases of compartment syndrome.  Prior to surgical 
intervention, the patient was unable to complete everyday 
tasks as a student. As pressure within their hypothenar, 
thenar, and interosseous compartments grew, the patient 
was no longer able to complete everyday fine motor skill 
tasks. A post-surgical rehabilitation plan was developed 
and implemented to improve the patient’s dexterity, grip 
strength, and range of motion. The patient successfully 
regained strength and dexterity by 8-week post-surgical 
intervention. Currently, the patient has not shown any 
recurrent signs and symptoms of compartment syndrome 
returning to any anatomical structure. However, it has been 
roughly four years since their diagnosis of Scleromyositis, 
they are no longer on immune suppressants, and their 
primary care physician found no evidence of the 
autoimmune disorder.  
 
Key Phrases 
College and University Patient Population, 
Diagnostic Testing and Physical Examination: Upper 
Extremity 

 
Correspondence 
Alyssa Vaniman, 11 S. Barranca Ave, West Covina, CA 
91791. 
E-mail: Alyssa.vaniman@gmail.com.    
Twitter: @thatladylyss  
 
Full Citation 
Vaniman A. Bi-lateral hand compartment syndrome 
secondary to autoimmune disorder in a former high 
school multi-sport athlete. Clin Pract Athl Train. 
2021;4(1): 57-60. 
https://doi.org/10.31622/2021/0004.1.7.   
 
Submitted: October 27, 2020 Accepted: April 8, 2021. 

 
INTRODUCTION  
 
According to the National Institutes of Health, 
approximately 24 million people in the United 
States suffer from an autoimmune disorder.1 In a 
healthy person, the immune system protects the 
body against disease and infection. However, in 

an individual who is diagnosed with an 
autoimmune disease, the immune system does not 
function properly, and wrongly starts attacking 
healthy cells. Scleromyositis is a unique and very 
rare overlap autoimmune disorder. Scleromyositis 
is classified as a cross-over disorder because the 
disease presents with both symptoms of 
scleroderma and myositis.2 Scleroderma is 
characterized by excessive collagen production 
and storage within a person’s connective tissues.3 
This excess collagen is coupled with inflammation 
of the muscles caused by symptoms of myositis. 
Scleroderma can develop within different 
anatomical structures throughout the body.3 
Depending on where the increase in collagen 
production takes place, this can lead to the 
inability to compete in athletics or even complete 
tasks associated with daily life. Due to the 
excessive amount of collagen production within 
the connective tissues paired with the significant 
amount of inflammation of muscle within the hand, 
the patient developed bilateral compartment 
syndrome of their hypothenar, thenar, and 
interosseous compartments. This inflammation and 
collagen production lead to the patient being 
unable to hold a pencil, drive, brush their hair, or 
compete in extramural athletics without severe 
pain. This particular patient had been managing 
developing compartment syndrome in multiple 
parts of their body without a proper diagnosis for 
years. The lack of answers from medical providers 
coupled with continued pain took a significant toll 
on the patient’s overall quality of life.  

PATIENT INFORMAITON 

Patient is a 21-year old female college senior 
participating in extramural athletics. The patient 
was a former high school multi-sport athlete who 
participated in repetitive impact sports for 

mailto:Alyssa.vaniman@gmail.com
https://doi.org/10.31622/2021/0004.1.7


Bi-Lateral Hand Compartment Syndrome Secondary to Autoimmune Disorder in a Former High School Multi-Sport Athlete 
 

 

58 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 4 – Issue 1 – February 2021 
 

multiple years (soccer, cross-country, basketball). 
The patient has a previous history of compartment 
syndrome in their anterior and superficial 
posterior compartment of the lower limbs as well 
as in the dorsal and superficial volar 
compartments of the forearms. Treatment included 
12 fasciotomies across the lower and upper 
extremities of their body in total over five years. 
The patient also has a previous history of 
endometriosis in addition to multiple cases of 
compartment syndrome. The medical team was 
introduced to the patient in the athletic training 
clinic after a formal diagnosis of scleromyositis 
was issued by the patient’s primary physician 
back home. Following this diagnosis, the patient 
was referred to an immunologist and 
rheumatologist to rule out the differential 
diagnosis of carpal tunnel syndrome, median 
nerve compression at the elbow, ulnar or cubital 
tunnel syndrome, brachioplexus pathology, or 
spinal stenosis. The patient stated that proper 
diagnosis was achieved after a series of extensive 
blood work to diagnosis the autoimmune disorder 
and compartment pressure measurement to 
diagnosis the bilateral compartment syndrome of 
the thenar, hypothenar, and interosseous 
compartments. As an out-of-state resident, the 
patient was making numerous trips to their home 
state of Wisconsin to get proper testing, follow-
ups, and formal visits with their primary physician 
and care team. The medical team was introduced 
to the patient after surgery to assist them with 
post-surgical rehabilitation.   

INTERVENTION 

To relieve the pain, diminished sensation, loss of 
grip strength, and dexterity, the patient 
underwent three simultaneous fasciotomies of the 
thenar, hypothenar, and interosseous 
compartments of both hands. When the patient 
first reported to the athletic training clinic, to the 
athletic training clinic, clinic staff (or whomever) 
conducted a preoperative evaluation. For the 
presurgical evaluation, the following assessment 

tools/diagnostic tools were used: Sollerman Hand 
Function test 4, hand-grip dynamometer, manual 
muscle testing, goniometry, blood pressure, 
reflexes, myotomes, and dermatomes, pulse 
oximeter, heart rate, and hand and forearm girth 
measurements. Because the patient would 
undergo anesthesia, medical staff chose to include 
vitals in pre and postoperative assessment to 
accurately monitor for adverse reactions 
following surgery. Two weeks post-surgery, the 
patient returned to the athletic training clinic for 
re-evaluation. The patient underwent the same 
preoperative qualitative and quantitative testing, 
and SOAP (explained in parenthesis) notes were 
completed every two weeks to monitor the 
patient’s postoperative results. Medical staff 
waited to implement the developed protocol until 
the patient was pain-free or 0/10 on a numeric 
pain scale, which was predicted to happen three-
weeks post-surgery. Due to pain limitations, the 
developed rehabilitation was not implemented 
until week four. Bi-weekly assessments and nerve 
flossing exercises were recommended in the 
interim. At four weeks postoperative, the patient 
was pain-free and able to start a rehabilitation 
regimen. Rehabilitation consisted of nerve flossing 
(ulnar, median, radial), passive and restive range 
of motion exercises of the wrist, 6-way wrist 
movements (flexion, extension, radial/ulnar 
deviation, supination, pronation), water cup pick 
up with various amounts of liquid, coloring in an 
adult coloring book with multiple writing 
implements, and the use of progressive resistive 
exercise putty. Formal rehabilitation sessions took 
place once a week in the athletic training clinic 
where the majority of these exercises were 
performed. The patient was encouraged to color 
and complete nerve flossing multiple times a 
week. 

OUTCOMES 

After surgical intervention, the patient’s nerve 
function fully returned after 5 weeks. The patient 
stated that their range of motion and strength 



Bi-Lateral Hand Compartment Syndrome Secondary to Autoimmune Disorder in a Former High School Multi-Sport Athlete 
 

 

59 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 4 – Issue 1 – February 2021 
 

returned to functional levels 8-10 weeks 
postoperative. However, the patient stopped 
coming into the athletic training clinic for 
scheduled rehabilitation appointments after seven 
weeks due to patient graduating and moving out 
of state. The patient’s relocation also meant 
testing values and SOAP notes at four weeks and 
six-week postoperative were unable to be 
completed. However, medical staff maintained 
communication with the patient for postoperative 
follow-up. After the surgical intervention, the 
patient has not redeveloped any signs or 
symptoms of compartment syndrome in the hands. 
As of June 2020, patient’s previously diagnosed 
autoimmune disorder is asymptomatic without the 
use of immunosuppressant medication. The patient 
was closely monitored by their primary care 
physician upon returning home and continues to 
have no symptoms of compartment syndrome. 

DISCUSSION 

The diagnosis of the injury in this patient’s case 
was extremely complex. Without a direct 
mechanism of injury and conflicting symptoms, the 
diagnosis remained unclear until the 
rheumatologist and immunologist confirmed with 
differential diagnostic testing. The patient and 
medical team also faced additional challenges 
during treatment:  the patient’s status as an out-
of-state resident, lack of insurance coverage due 
to patient’s out-of-state status, and a lack of 
expertise in autoimmune disorders at the 
treatment facility. This patient’s case was unique 
with regard to epidemiology – the case 
presentation was individual and atypical. Due to 
the complex nature of this case, medical 
professionals from various specialties were 
involved in the diagnosis, treatment, and 
rehabilitation of this patient. It is important to note 
that an accurate diagnosis would have been 
unlikely without proper referrals and the patient’s 
quality of life and functional capabilities would 
have continued to suffer. More importantly, 
without the proper referrals during the diagnosis, 

treatment, and rehabilitation phases the patient’s 
quality of life and functional capabilities would 
have continued to suffer.  

CLINICAL BOTTOM LINE 

When diagnosing a patient, referral for clinical 
lab testing, alternate diagnostic tools, and 
referral to the appropriate medical professional 
team could be the defining factors in proper 
diagnosis and treatment for your patient. Athletic 
trainers are a valuable piece of the sports 
medicine team that work collaboratively with 
other medical professionals in diagnosis and 
treatment of illness and injury. This case serves as 
a great reminder that athletic trainers are a 
critical component of the healthcare team and 
often serve as facilitators for communication and 
collaboration among team members, ensuring the 
patient receives the highest possible level of care. 

REFERENCES 

1. The Autoimmune Diseases Coordinating 
Committee. U.S. Department of Health 
and Human Services; 2005. 
https://www.niaid.nih.gov/sites/default/
files/adccfinal.pdf. Accessed July 7, 
2020. 

2. Venables PJ. Polymyositis-associated 
overlap syndromes. Br J Rheumatol. 
1996;35(4):305-306. 
https://doi.org/10.1093/rheumatology
/35.4.305.  

3. Bhansing KJ, Lammens M, Knaapen HK, 
van Riel PL, van Engelen BG, Vonk MC. 
Scleroderma-polymyositis overlap 
syndrome versus idiopathic polymyositis 
and systemic sclerosis: A descriptive 
study on clinical features and 
myopathology. Arthritis Res Ther. 
2014;16(3):R111. 
https://doi.org/10.1186/ar4562.  

https://doi.org/10.1093/rheumatology/35.4.305
https://doi.org/10.1093/rheumatology/35.4.305
https://doi.org/10.1186/ar4562


Bi-Lateral Hand Compartment Syndrome Secondary to Autoimmune Disorder in a Former High School Multi-Sport Athlete 
 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                        Volume 4 – Issue 1 – February 2021 
 

4. Sollerman C, Ejeskär A. Sollerman. Hand 
function test: A standardised method and 
its use in tetraplegic patients. Scand J 
Plast Reconstr Surg Hand Surg. 
2009;1995;29:167-176. 
https://doi.org/10.3109/0284431950
9034334.  

 

 

https://doi.org/10.3109/02844319509034334
https://doi.org/10.3109/02844319509034334

	ABSTRACT

