ARM PUMP SURGERY: IS IT FOR YOU?

A few articles ago we discussed the ins and outs of arm pump, a debilitating condition that has plagued many dirt bike riders over the years. In this weeks featured article, we?ll take a look at an operative solution to fixing this nagging condition.

To Review?
Arm pump occurs when contractions prevent blood flow into the muscle, which results in the build up of potassium and phosphate. When this happens, the potassium and phosphate cannot be flushed away from the muscle by the blood and therefore, arm pump occurs.

When fatigued, studies have shown that the action potential is not actually affected or weakened, but the difference between the muscles causes a rapid fall in the ability to develop strength. This is where the so-called burning sensation comes from, the overworking of the muscles and toxin accumulation. While gripping the handlebars and consistently pulling the clutch, the main flexing muscles in the wrist and fingers have to work overtime. When these muscles are working so fast, they tend to tire quickly and arm pump soon sets in. Unfortunately, when arm pump has plagued your forearms, there isn?t much you can immediately do, besides wait it out.

While numbness or tingling may occur, these common symptoms only last for a short while and will soon subside after your arms are given a chance to rest. However, some riders experience extreme pain, numbness, or tingling for extended periods of time even after they have finished riding. In a case like this, if your pain would happen to continue for a long period of time after you have stopped riding, or if the pain increases, medical doctors recommend that you get medical attention immediately.

The Operation
Since a majority of both pro and amateur riders suffer from arm pump, many of them are opting to have surgery to fix the problem. Fasciotomy, which is the medical term for this procedure, is becoming an increasing trend for a lot of riders.

Fasciotomy is a surgical procedure that cuts away the fascia, the tissue around the outside of a muscle, to relieve tension or pressure. It will often times vary in thickness, composition, density, and elasticity, depending on which muscle of the body it is covering. Even though it may sound similar to a ligament or tendon, it is in fact, much different. The fascia is commonly injured through continuous strain or some type of severe trauma to the forearm.

Many experts will agree that if a rider still suffers from arm pump after 9 to 12 continuous months of non-operative treatment, which is performed under the supervision of a doctor, a fasciotomy may be performed.

Any trained Orthopaedic Surgeon can easily perform this procedure, which is done under general or regional anesthesia. Even though this particular procedure isn?t a new concept to many surgeons, it is more commonly operated on the leg than the forearm. In addition, it is also performed on patients who have suffered some type of severe trauma, which includes the treatment and prevention of acute compartment syndrome, also known as ACS. (ACS is a progressive, painful loss of function within the muscles and nerves that happens most commonly in the leg or arm. It takes place when bleeding and swelling get in the way of proper blood circulation of the muscle and nerve tissues. As the tissue pressure increases, it decreases blood flow, in both the veins and arteries. In return, nerve and muscle cells start to die off within 4 to 8 hours.)

Scapula Please
Overall, a fasciotomy is a fairly simple procedure. The surgeon will first make an incision on the inside of the forearms in order to reach the fascia. Then the surgeon will either do one of two things: either cut a piece of the fascia, which is also known as releasing the fascia, or actually remove a strip of it.

Since the arm consists of four fascial compartments (see diagram above), all of the compartments can be released by making only two incisions. The first incision, which is known as a volar incision, will be toward the front of the body. This will allow for the surgeon to remove the superficial volar and deep volar compartments. The second and final incision, known as the dorsal incision, allows for the dorsal and mobile wad compartments to be removed. The dorsal incision is made toward the back of the body. Research has shown that these four separate compartments are often unified with one another and an effective procedure can be done by simply releasing the volar compartments only. Once complete, the connective tissue will grow back which in essence, will lengthen the fascia, making the surgery effective.

After the Operation
Since this type of operation is fairly simple, requiring little or no preparation for the patient, recovery time is a fast process. The procedure itself is done on an outpatient basis, which means there is no overnight stay involved. The surgery itself will usually last anywhere from 20 minutes to one hour, depending on the severity of the case. A patient can begin doing everyday functions quite rapidly after the surgery, usually within 1 to 2 days. Riders can begin to train after 2 to 3 weeks and start to compete 4 to 6 weeks later.

To Cut or Not to Cut
While this may sound like an ideal and quick fix to your arm pump problems, it is always best to consult your local doctor first. He or she may suggest different alternatives before going under the knife. Since a fasciotomy isn?t for everyone, your doctor may have suggestions that you may find helpful in reducing and preventing arm pump in the future. Another thing to keep in mind is the fact that this type of surgery doesn?t always work after the first procedure. Some riders have to go back in for a second round of surgery. Even though most riders are healed after their first fasciotomy, this is always one thing to consider.

“EVS ? Winning with Safety”