TITLE:
Atraumatic Biceps Hematoma Leading to Acute Compartment Syndrome in an Elderly Patient: Diagnostic and Management Challenges
AUTHORS:
Sharifa Mohieldin, Andrea Sharp, Rachelle Beste, Kara Bragg
KEYWORDS:
Acute Compartment Syndrome, Biceps Hematoma, Atraumatic Muscle Injury, Elderly Patient, Anticoagulation, Fasciotomy, Emergency Department, Limb Salvage, Diagnostic Challenges, Musculoskeletal Complications
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.14 No.4,
October
27,
2026
ABSTRACT: Acute compartment syndrome (ACS) is a time-sensitive surgical emergency that can lead to profound consequences which can endanger the limb and life of the patient if it is not rapidly diagnosed and promptly treated. While disproportionate pain and pronounced firm swelling are typically regarded as the defining symptoms and are often precipitated by traumatic injury, atypical presentations that lack significant tense edema and traumatic or compressive causes have been described. We report the case of an 81-year-old male who presented with severe right arm pain and paresthesia; the pain started suddenly while he was holding a dinner plate in his right hand and subsequently developed rapidly progressive compartment syndrome in the right arm and forearm. The diagnosis was inferred from observable findings such as significant tenderness in the right arm, tense swelling, diminished touch sensation, and reduced distal pulses. The decision to proceed with urgent fasciotomy in the operating room was based on examination findings and clinical judgment. This case underscores the necessity of being vigilant for ACS in patients who have not experienced significant trauma, even when there are no pronounced tense or firm compartments upon examination. It advocates prompt intervention to avert irreversible complications.