An Atypical Cause Of Persistent Elbow Pain In A Recreational Athlete - Page #1

Author: Samuel Thompson, BS
Co Author #1: Andrea J. Evenski, MD
Co Author #2: Aaron D. Gray, MD

Patient Presentation:
A 40-year old recreational athlete presented with an eight-year history of left elbow pain.

Three years prior, a radiograph at an outside hospital revealed a left elbow bone lesion. At that time the patient did not have insurance and could not afford a follow-up visit.

At presentation, the patientís elbow pain was constant, sharp, and eight out of ten on a pain scale. The pain was exacerbated with pronation of the wrist and raising the left arm above the head. Patient was using Ibuprofen for pain control.

The pain radiated down the left forearm. He experienced frequent left hand spams with numbness and paresthesias in the third through fifth digits. There was no history of trauma or injury. No fevers, chills, weight loss, or night sweats.

Physical Exam:
Left elbow: No erythema, swelling, or increased warmth. No visible mass. Severe tenderness to palpation of proximal olecranon. No tenderness over the medial and lateral epicondyles. Full pronation and supination without pain. Full strength with resistance to pronation and supination of the hand, as well as with flexion and extension of the wrist. Normal pulses and no lymphedema. Moderate atrophy of the left forearm muscles in comparison to the right. Normal sensation to light touch in the left hand. Reflexes normal. Shooting sensation radiating into the fourth and fifth fingers with positive Tinelís sign of the cubital tunnel.

Shoulders: No abnormalities on bilateral shoulder exam.

Neck: Full range of motion and negative Spurlingís.

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