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Compartment Syndrome of the Upper Limb

43 citationsUpdated Sep 2026

Overview

Acute compartment syndrome of the upper extremity is a rare but serious condition that can affect the upper arm, forearm, and hand, requiring prompt diagnosis and emergent fasciotomy to prevent myonecrosis, contracture, and limb dysfunction [1, 4]. While often associated with the forearm and leg, clinicians must recognize that this pathology occurs in the upper arm to avoid the serious consequences of missed or misdiagnosed cases [1]. The condition results from high tissue fluid pressures that reduce capillary perfusion below levels necessary for tissue viability [10]. Minimizing the time to surgical decompression is critical to optimize patient outcomes, and adequate decompression of the 10 anatomic compartments of the hand is necessary at the time of fasciotomy [6]. Although acute exertional compartment syndrome is a rare but real condition that must be taken seriously [5], chronic upper extremity compartment syndrome is rare but should be considered with appropriate history [2].

Causes are categorized into decreased compartment size and increased compartment content [3]. Specific etiologies include prolonged external compression from a pneumatic tourniquet [7], hereditary angioedema, which must be considered when patients present with compartment syndrome of unknown etiology [20], and the opioid epidemic, which has led to a rise in 'found down' compartment syndrome [8]. The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with prior literature [8]. When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders such as systemic capillary leak syndrome and aggressively treat both the compartment syndrome and the underlying disease [15]. Additionally, phlegmasia cerulea dolens of the upper extremity should raise concern for an associated compartment syndrome [14].

Diagnosis of chronic upper extremity compartment syndrome is aided by intramuscular pressure measurement and MRI before and after load, whereas angiography is not helpful [2]. Elevated creatine kinase levels above 300 U/L serve as a useful screening test for the highest risk patients with acute forearm compartment syndrome [22]. Combining identified risk factors with clinical signs and symptoms would make a more accurate predictor model for the need for fasciotomy, though further studies are needed to validate mathematical models using mutually exclusive data subsets [12]. While the authors argue that mandatory surgical intervention for compartment syndrome is in doubt, revascularization may contribute to crush syndrome due to reperfusion injury [21]. Upper-extremity acute limb ischemia revascularization carries a high complication rate [34].

Anatomy & Pathophysiology

Compartment Anatomy & Distribution

Acute compartment syndrome of the upper extremity is a rare but serious condition [4], while chronic compartment syndrome of the upper extremity is rare [2]. Acute exertional compartment syndrome (AECS) of the upper extremity is also a rare but real condition [5]. Compartment syndromes have been recognized in the calf and forearm compartments, and more recently in the upper arm, buttock, and thigh [18]. The forearm contains three compartments: dorsal, mobile wad, and volar [11]. The hand contains 10 anatomic compartments that require adequate decompression at the time of fasciotomy [6].

Pathophysiology & Mechanisms

Prolonged external compression from a pneumatic tourniquet can cause compartment syndrome of the arm [7]. Upper-extremity acute limb ischemia (ALI) revascularization has a high complication rate [34]. Rhabdomyolysis is a neglected priority in the early management of severe limb trauma [27]. Early surgical intervention with fasciotomy allows optimal muscle regeneration, leading to complete functional recovery in cases of familial rhabdomyolysis [24].

Clinical Presentation & Risk Factors

Clinicians should recognize that acute compartment syndrome can occur in the upper arm to avoid serious consequences caused by missed diagnosis and misdiagnosis [1]. The demographics of acute hand compartment syndrome have evolved in the last 25 years, partly as a result of the opioid epidemic leading to a rise in 'found down' compartment syndrome [8]. Children sustaining displaced distal radius and ulna fractures are an at-risk group for acute compartment syndrome and should be carefully observed [28]. Those with absent function at the time of presentation are unlikely to gain function after fasciotomy [29].

Diagnostic Modalities: Diagnosis of chronic compartment syndrome is aided by intramuscular pressure measurement and MRI before and after load, while angiography is not helpful [2]. Acute carpal tunnel syndrome should be suspected in patients with median nerves demonstrating increased cross-sectional area and adopting a more circular shape [66]. Pseudogout should be considered a rare cause of acute neuropathic compression of the hand [71]. Atraumatic acute carpal tunnel syndrome is a rare disorder with various etiologies, requiring accurate diagnosis through careful history and examination [33]. Thorough investigation of nerve function is important even in cases with apparently minor injuries [70].

Sequelae & Late Management

Acute compartment syndrome of the upper extremity requires prompt diagnosis and emergent fasciotomy to prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction [4]. Minimizing the time to surgical decompression in a patient diagnosed with compartment syndrome is critical to optimize patient outcome [6]. When the limb affected by the compartment syndrome is not adequately decompressed at an early stage, a different set of problems arises in late management [18]. Reconstructive procedures can be performed to improve the function of the affected upper extremity in the patient with Volkmann contracture; however, return of normal function should not be expected [45]. Timely carpal tunnel decompression allows a return to normal sensation and function of the hand [63].

Classification

Etiological Categories: Upper extremity compartment syndrome causes are categorized into two primary mechanisms: decreased compartment size and increased compartment content [3]. While acute compartment syndrome is classified as a rare but serious condition requiring prompt diagnosis and emergent fasciotomy [4], chronic compartment syndrome is a rare entity that should be considered based on appropriate history [2]. Acute exertional compartment syndrome (AECS) is a distinct, rare condition that must be taken seriously [5].

Anatomical Distribution: Compartment syndrome of the upper arm is a recognized entity distinct from the more common forearm syndromes [1, 7]. Although the calf and forearm are frequent sites, compartment syndrome can also occur in the upper arm, buttock, and thigh [18].

Specific Etiologies and Syndromes: Phlegmasia cerulea dolens of the upper extremity is a specific cause that should raise concern for associated compartment syndrome [14]. Systemic disorders, such as Systemic Capillary Leak Syndrome (SCLS), can present as multiple extremity compartment syndrome [15]. Soft tissue sarcoma is a rare cause of compartment syndrome that should be considered in cases without clear trauma [25]. Opioid-related "found down" scenarios represent a distinct demographic and etiological subset of acute compartment syndrome [8, 30].

Traumatic and Temporal Classifications: Traumatic rhabdomyolysis conditions, including crush syndrome and compartment syndrome, are classified based on mechanism, ischemia time, and the presence or absence of compartment syndrome [64]. Within this framework, the "found down" patient represents a separate subset of traumatic rhabdomyolysis cases [64]. Late compartment syndrome is classified as having a distinct presentation and outcomes from acute compartment syndrome [64].

Clinical Presentation

Acute exertional compartment syndrome (AECS) of the upper extremity is a rare but real condition that must be taken seriously [5]. While trauma is a common precipitant, several non-traumatic and systemic etiologies exist. Pharmacological agents that can predispose to rhabdomyolysis can lead to compartment syndrome [43]. Eosinophilic fasciitis is a possible although uncommon atraumatic cause of compartment syndrome [44]. Soft tissue sarcoma is a rare cause of compartment syndrome without clear trauma [25].

When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders such as Systemic Capillary Leak Syndrome (SCLS) [15]. Diagnostic imaging has limited utility in specific contexts; angiography is not helpful for the diagnosis of chronic upper extremity compartment syndrome [2].

Investigations

Physical Examination: A careful physical examination is essential to direct care and determine if future testing is indicated for the injured or dysfunctional hand and wrist [36]. While diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology, they can be expensive, time-consuming, and often nonspecific [36].

MRI: MRI is probably most useful in identifying additional pathology, such as flexor tendon bowstringing, in the context of Dupuytren's disease [60]. It may also provide a quantitative noninvasive measure of cellularity in affected areas, which serves as an index of biologic activity [60]. For chronic compartment syndrome of the upper extremity, MRI performed before and after load aids in diagnosis [2].

Intramuscular Pressure Measurement: Intramuscular pressure measurement before and after load aids in the diagnosis of chronic compartment syndrome of the upper extremity [2].

Angiography: Angiography is not helpful for the diagnosis of chronic compartment syndrome of the upper extremity [2].

Doppler Assessment: An 8-MHz Doppler tone assessment may be used to identify superficially displaced neurovascular bundles when Dupuytren cords lie beneath soft fleshy prominences [60]. However, false-negatives are possible with this assessment for identifying neurovascular bundles [60].

Laboratory: Biomarkers are seldom used in the context of acute fasciotomy of the lower leg [46].

Treatment

Non-Operative

The chronic form of the syndrome can be managed by activity restriction [26]. If symptoms persist despite conservative measures, fasciotomy is indicated [26].

Operative

Indications: Acute compartment syndrome of the upper extremity requires prompt diagnosis and emergent fasciotomy to optimize patient outcomes and prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction [4]. When the limb affected by the compartment syndrome is not adequately decompressed at an early stage, a different set of problems arises that requires highlighting the importance of physical signs and surgical intervention in late management [18].

Surgical Approach / Technique: Adequate decompression of the 10 anatomic compartments of the hand is necessary at the time of fasciotomy for hand compartment syndrome [6]. In a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad) [11]. Fasciotomy through multiple small skin incisions is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children, capable of decompressing compartment pressure with fewer complications [32].

Other Considerations: The authors argue that mandatory surgical intervention for compartment syndrome is in doubt and that revascularization may contribute to crush syndrome due to reperfusion injury [21]. When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders, such as SCLS, and aggressively treat the compartment syndrome as well as the underlying disease [15].

Etiology-Specific Considerations: Administration of antivenin is the currently recommended mainstay of treatment for snakebites in the upper extremity, with judicious application of surgical intervention in cases concerning for compartment syndrome, tissue necrosis, and limb compromise [23].

Complications

Tissue Viability and Necrosis: Acute compartment syndrome of the upper extremity can result in myonecrosis [4]. High tissue fluid pressures from acute compartment syndrome can reduce capillary perfusion below a level necessary for tissue viability [10].

Functional Deficits: Acute compartment syndrome of the upper extremity can result in contracture [4] and limb dysfunction [4]. Patients with absent function at the time of presentation are unlikely to gain function after fasciotomy [29].

Timing of Intervention: Late fasciotomy is associated with greater residual functional deficits compared to early fasciotomy [41]. Late fasciotomy is also associated with greater post-fasciotomy complications compared to early fasciotomy [41].

Recovery

Other Considerations: Early recognition and emergency surgical decompression within hours of birth can achieve good long-term functional results and prevent sequelae such as Volkmann syndrome in neonatal compartment syndrome [65]. The standard management of acute cases of compartment syndrome by decompressive fasciotomy is well understood [18]. When the limb affected by the compartment syndrome is not adequately decompressed at an early stage, a different set of problems arises [18].

Key Evidence

  • [Case_report] Clinicians should fully recognize that acute compartment syndrome can occur in the upper arm, rather than only the forearm and leg, to avoid serious consequences caused by missed diagnosis and misdiagnosis. [1] (10.1186/s12891-021-04318-1)
  • [L4] Chronic compartment syndrome of the upper extremity is rare but should be considered with appropriate history; diagnosis is aided by intramuscular pressure measurement and MRI before and after load, while angiography is not helpful. [2] (10.1055/s-2006-923785)
  • [L5] This article describes the various causes of upper extremity compartment syndrome, categorizing them into decreased compartment size and increased compartment content. [3] (10.1016/s0749-0712(21)00395-4)
  • [L5] Acute compartment syndrome of the upper extremity is a rare but serious condition requiring prompt diagnosis and emergent fasciotomy to optimize patient outcomes and prevent adverse sequelae such as myonecrosis, contracture, and limb dysfunction. [4] (10.1016/j.jhsa.2025.07.021)
  • [L5] Acute exertional compartment syndrome (AECS) of the upper extremity is a rare but real condition that must be taken seriously. [5] (10.5435/jaaosglobal-d-19-00017)
  • [L5] Minimizing the time to surgical decompression in a patient diagnosed with compartment syndrome is critical to optimize patient outcome, and adequate decompression of the 10 anatomic compartments of the hand is necessary at the time of fasciotomy. [6] (10.1016/j.hcl.2017.09.005)
  • [Case_report] The case report describes a rare instance of compartment syndrome of the arm caused by prolonged external compression from a pneumatic tourniquet, distinct from the more common forearm syndromes. [7] (10.2106/00004623-198466040-00027)
  • [L4] The demographics of acute hand compartment syndrome have evolved in the last 25 years compared with the prior literature, partly as a result of the opioid epidemic leading to a rise in 'found down' compartment syndrome. [8] (10.1177/15589447221084012)
  • [L5] Forearm fasciotomy of the relevant compartment should be performed to decompress the compartment and gain a good functional outcome. [9] (10.1016/s0020-1383(02)00304-2)
  • [Paper] Acute compartment syndrome results in high tissue fluid pressures that can reduce capillary perfusion below a level necessary for tissue viability. [10] (10.1016/s0749-0712(21)00406-6)
  • [L5] In a laboratory model of an acute forearm compartment syndrome, a single compartment fasciotomy may be sufficient to decrease compartment pressures in the non-released compartments (dorsal and mobile wad). [11] (10.1016/j.injury.2012.08.006)
  • [L5] The authors suggest that combining identified risk factors with clinical signs and symptoms would make a more accurate predictor model for compartment syndrome and the need for fasciotomy, and that further studies are needed to validate mathematical models using mutually exclusive data subsets. [12] (10.1016/j.injury.2011.08.007)
  • [Case_report] Phlegmasia cerulea dolens of the upper extremity should raise the clinician's concern for an associated compartment syndrome. [14] (10.1016/j.jhsa.2009.08.003)
  • [L4] When faced with clinical evidence of multiple extremity compartment syndrome, the surgeon should consider systemic disorders, such as SCLS, and aggressively treat the compartment syndrome as well as the underlying disease. [15] (10.1007/s11552-010-9305-5)
  • [L4] Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm. [16] (10.1177/1753193410397900)
  • [L4] [18] (10.1016/0020-1383(95)00112-m)
  • [Case_report] Hereditary angioedema is a rare but known cause of compartment syndrome of the upper extremity and must be considered when patients present with compartment syndrome of unknown etiology. [20] (10.1177/1558944716668830)
  • [L5] The authors argue that mandatory surgical intervention for compartment syndrome is in doubt and that revascularization may contribute to crush syndrome due to reperfusion injury. [21] (10.1016/0020-1383(94)90169-4)
  • [L3] Elevated creatine kinase levels above 300 U/L are a useful screening test for the highest risk patients with acute forearm compartment syndrome. [22] (10.1177/1558944719884662)
  • [L4] Administration of antivenin is the currently recommended mainstay of treatment, with judicious application of surgical intervention in cases concerning for compartment syndrome, tissue necrosis, and limb compromise. [23] (10.1016/j.jhsa.2018.06.016)
  • [L5] Early surgical intervention with fasciotomy played a substantial role in allowing optimal muscle regeneration, leading to complete functional recovery. [24] (10.2106/00004623-200211000-00021)
  • [L4] This case highlights the importance of considering rare causes, like soft tissue sarcoma, in cases of compartment syndrome without clear trauma. [25] (10.1016/j.jhsg.2025.01.003)
  • [L4] Surgical fasciotomy was not performed for these patients. [27] (10.1016/0020-1383(94)90168-6)
  • [L4] Children sustaining displaced distal radius and ulna fractures are an at-risk group for acute compartment syndrome and should be carefully observed. [28] (10.1016/0020-1383(90)90057-2)
  • [L4] Those with absent function at the time of presentation are unlikely to gain function after fasciotomy. [29] (10.2106/jbjs.18.01307)
  • [L3] [30] (10.1016/j.injury.2019.06.013)
  • [L4] Fasciotomy through multiple small skin incisions is a simple and effective strategy for the treatment of early osteofascial compartment syndrome in children, capable of decompressing compartment pressure with fewer complications. [32] (10.1186/s13018-020-01742-2)
  • [L5] Atraumatic acute carpal tunnel syndrome is a rare disorder with various etiologies; this case highlights the importance of accurate diagnosis through careful history and examination, followed by prompt surgical exploration and carpal tunnel release. [33] (10.1007/s00402-017-2730-y)
  • [L3] Upper-extremity ALI revascularization has a high complication rate. [34] (10.1016/j.jhsa.2025.08.005)
  • [L4] Early fasciotomy (within twelve hours) significantly diminishes residual functional deficits and post-fasciotomy complications compared to late fasciotomy. [41] (10.2106/00004623-197658010-00020)
  • [L4] Surgeons should be aware of pharmacological agents that can predispose to rhabdomyolysis because these can lead to compartment syndrome. [43] (10.1016/j.jhsa.2019.04.002)
  • [Case_report] Surgeons should be mindful about atraumatic causes of compartment syndrome and should consider eosinophilic fasciitis as a possible although uncommon cause. [44] (10.1016/j.jhsa.2015.01.003)
  • [L4] Reconstructive procedures can be performed to improve the function of the affected upper extremity in the patient with Volkmann contracture; however, return of normal function should not be expected. [45] (10.5435/00124635-201101000-00006)
  • [L4] Biomarkers are seldom used in the context of acute fasciotomy of the lower leg. [46] (10.1186/s12891-018-2394-y)
  • [L4] Timely carpal tunnel decompression allows a return to normal sensation and function of the hand. [63] (10.1016/j.jhsg.2022.04.012)
  • [L5] [64] (10.5435/jaaos-d-23-00734)
  • [Case_report] Early recognition and emergency surgical decompression within hours of birth can achieve good long-term functional results and prevent sequelae such as Volkmann syndrome in neonatal compartment syndrome. [65] (10.1016/j.jhsa.2013.03.029)
  • [L3] Acute carpal tunnel syndrome should be suspected in patients with median nerves demonstrating increased cross-sectional area and adopting a more circular shape. [66] (10.1016/j.jhsg.2023.03.013)
  • [L5] This shows the importance of a thorough investigation of the nerve function even in cases with apparently minor injuries. [70] (10.1016/0020-1383(84)90160-8)
  • [L4] Pseudogout should be considered a rare cause of acute neuropathic compression of the hand. [71] (10.1016/j.jhsg.2022.07.010)

See Also

  • Dupuytren's Disease

References

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[5] Acute Exertional Compartment Syndrome of Bilateral Upper Extremities After a Push-up Contest. JAAOS: Global Research and Reviews. 2019. DOI: 10.5435/jaaosglobal-d-19-00017

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[8] Surgical Demographics of Acute Hand Compartment Syndrome. HAND. 2022. DOI: 10.1177/15589447221084012

[9] Unexplained bilateral extensor and unilateral flexor acute compartment syndrome of the forearm. Injury. 2004. DOI: 10.1016/s0020-1383(02)00304-2

[10] VOLKMANN’S ISCHEMIC CONTRACTURE OF THE UPPER EXTREMITY. Hand Clinics. 1998. DOI: 10.1016/s0749-0712(21)00406-6

[11] A single volar incision fasciotomy will decompress all three forearm compartments: A cadaver study. Injury. 2012. DOI: 10.1016/j.injury.2012.08.006

[12] Incidence and predictors for the need for fasciotomy after extremity trauma. Injury. 2012. DOI: 10.1016/j.injury.2011.08.007

[14] Upper Extremity Compartment Syndrome in the Setting of Deep Venous Thrombosis and Phlegmasia Cerulea Dolens: Case Report. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.08.003

[15] Compartment Syndrome in all Four Extremities: A Rare Case Associated with Systemic Capillary Leak Syndrome. HAND. 2010. DOI: 10.1007/s11552-010-9305-5

[16] Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy. Journal of Hand Surgery (European Volume). 2011. DOI: 10.1177/1753193410397900

[18] Late management of compartment syndromes. Injury. 1995. DOI: 10.1016/0020-1383(95)00112-m

[20] Pediatric Hereditary Angioedema as a Cause of Acute Compartment Syndrome of the Hand and Forearm: A Case Report. HAND. 2016. DOI: 10.1177/1558944716668830

[21] Cortical bone screws. Injury. 1994. DOI: 10.1016/0020-1383(94)90169-4

[22] Factors Associated With Poor Outcomes in Acute Forearm Compartment Syndrome. HAND. 2019. DOI: 10.1177/1558944719884662

[23] Management of Snakebites in the Upper Extremity. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.06.016

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[25] Forearm Compartment Release with Incidental Soft Tissue Sarcoma. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.01.003

[26] Anterior Tibial Compartment Syndrome: ACUTE AND CHRONIC.. The Journal of Bone and Joint Surgery. American Volume. 1967.

[27] Rhabdomyolysis: a neglected priority in the early management of severe limb trauma. Injury. 1994. DOI: 10.1016/0020-1383(94)90168-6

[28] Compartment syndrome following forearm fracture in children. Injury. 1990. DOI: 10.1016/0020-1383(90)90057-2

[29] “Found Down” Compartment Syndrome. Journal of Bone and Joint Surgery. 2019. DOI: 10.2106/jbjs.18.01307

[30] Opioid-related compartment syndrome and associated morbidity. Injury. 2019. DOI: 10.1016/j.injury.2019.06.013

[32] Fasciotomy through multiple small skin incisions for the treatment of early acute osteofascial compartment syndrome in children. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01742-2

[33] Recurrent atraumatic acute carpal tunnel syndrome due to hematoma caused by distal radioulnar joint arthritis during anticoagulant treatment with apixaban. Archives of Orthopaedic and Trauma Surgery. 2017. DOI: 10.1007/s00402-017-2730-y

[34] Outcomes of Upper-Extremity Revascularization Following Acute Limb Ischemia. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2025.08.005

[36] Orthopaedic Knowledge Update 13 Ebook Without Multimedia. Anatomy, Evaluation, Clinical Examination, and Imaging > Evaluation and Clinical Examination: Current Concepts.

[41] Fasciotomy in the treatment of the acute compartment syndrome. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00020

[43] Acute Bilateral Compartment Syndrome of the Forearms. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2019.04.002

[44] Forearm Compartment Syndrome as a Result of Eosinophilic Fasciitis: Case Report. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.01.003

[45] Acute Compartment Syndrome of the Upper Extremity. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201101000-00006

[46] Low compartment pressure and myoglobin levels in tibial fractures with suspected acute compartment syndrome. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-018-2394-y

[60] Dupuytren S Disease And Related Hyperproliferative Disorders. 54. The Future of Dupuytren’s Research and Treatment > 54.4 Mechanical Measurements and Procedures > 54.4.4 Imaging.

[63] Acute Carpal Tunnel Syndrome Secondary to Gout Flare and Outcomes at 18 Months After Open Carpal Tunnel Decompression. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.04.012

[64] Traumatic Rhabdomyolysis: Crush Syndrome, Compartment Syndrome, and the ‘Found Down’ Patient. Journal of the American Academy of Orthopaedic Surgeons. 2023. DOI: 10.5435/jaaos-d-23-00734

[65] Successful Early Surgical Treatment in Neonatal Compartment Syndrome: Case Report. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.03.029

[66] Utility of Ultrasound for Identifying Median Nerve Changes Indicative of Acute Carpal Tunnel Syndrome After Distal Radius Fracture. Journal of Hand Surgery Global Online. 2023. DOI: 10.1016/j.jhsg.2023.03.013

[70] Acute carpal tunnel syndrome caused by fracture of the scaphoid and the 5th metacarpal bones. Injury. 1984. DOI: 10.1016/0020-1383(84)90160-8

[71] Pseudogout: A Rare Cause of Acute Carpal Tunnel Syndrome and Acute Guyon Canal Syndrome. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.07.010

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k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.