Author: Ryan Bart, DO
Co Author #1: Chris Colvin, DO
Co Author #2: Carl Covey, MD
Co Author #3: Dana Hess, MD
Senior Editor: Warren Bodine, DO, FAMSSM
Editor: Marlee Hahn, MD

Patient Presentation:
A 27-year-old right hand dominant male presented with right-sided volar forearm pain and associated mass.

History:
He has had similar intermittent symptoms since 2009. They have worsened over the last 3 months since increasing strenuous activity and starting competitive Jiu Jitsu. He also complains of a 'bulge' in the area of his forearm pain that has been present for years, but increasing in size over the last 3 months. The pain usually worsens after an extended period of activity, lasting hours after the activity. He denies any injury. Previous NCS/EMG studies and a forearm ultrasound were unremarkable. He has completed 6-weeks of physical therapy without improvement in his symptoms.

Physical Exam:
General: WDWN. NAD.
Neurovascular: No focal deficits of the bilateral upper extremities.

Wrist/Elbow: Bilateral
Inspection: Bilateral volar forearm mass just proximal to distal wrist crease, right greater than left. No skin changes, no scars, or tattoos, no signs of trauma/injury.
Palpation: 2cm x 4cm mass that is non-tender on right volar forearm just proximal to distal wrist crease. Left is similar however less prominent.
ROM: full and equal bilaterally, no crepitus.
Strength: 5/5 and equal bilateral

Hand/Finger Exam: Bilateral
No abnormalities with inspection/palpation/ROM/strength.

Provocative maneuvers: Bilateral
Negative Tinels over mass, median nerve, and Guyons canal at the wrist.
TFCC Stress: Mildly positive on the right with minor discomfort.

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