Also the potential for developing compartment syndrome and subsequently Volkmann's ischaemic contracture (VIC), which is usually seen in children with supra-condylar # of humerus or forearm #, but also common following tibial fractures or indeed any injury followed by a inappropriately tight bandaging.
Any cause of increased swelling in a tight fascial compartment can impair the venous circulation (but arterial circulation may continue, further increasing the intracompartmental pressure). Muscle necrosis can be very fast and irreversible, requiring extensive debridements and permanent contractures, nerve and vascular injuries.
It is a different entity from exertional rhabdomyolysis and some individuals may be more prone than others.
I am not sure Ix for metabolic myopathy can be ignored here, but he definitely needs counselling to avoid developing a potentially disabling contracture in the future.
BW
Rajeev
Rajeev Srivastava
SpR Biochemical Medicine
Ninewells Hospital
Dundee
DD1 9SY
________________________________________
From: Clinical biochemistry discussion list [[log in to unmask]] On Behalf Of Colley, Michael [[log in to unmask]]
Sent: 26 August 2009 10:49
To: [log in to unmask]
Subject: Re: High CK - ?further investigation
Most certainly.
One of our technicians (yes it was that long ago) measured his CK before
and after running a marathon. Although it had been normal before it was
still in the tens of thousands next morning and returned to normal after
several days.
I would feel that no further investigation is needed.
Michael
Dr C M Colley
Consultant Chemical Pathologist
Great Western Hospital
Swindon SN3 6BB
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of Robert Lord
Sent: 26 August 2009 10:33
To: [log in to unmask]
Subject: High CK - ?further investigation
Reviewing a set of medical notes today on a 24 yr old male who was
admitted in July with a CK of 35,825. Swelling of both arms having spent
all day laying slabs in his garden.
Apparently had similar episode in Jan following exercise at gym.
Otherwise well. Medication = inhalers for asthma.
O/E muscles in both arms swollen and tender. Other tests - TSH = normal,
CRP = normal, U+E = normal, FBC = normal, ALT = 165, LDH = 1243.
Elevated urine myoglobin = 124 ug/L. Treated with iv fluids. CK = 7203
when discharged 3 days later. No follow up has been arranged.
Do you see this kind of self induced increase in CK due to strenuous
exercise or should I be suggesting follow up regarding investigation of
a possible metabolic myopathy?
Many thanks
Rob
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