Exertional Hand Paresthesias And Skin Changes In A Runner - Page #1

Author: Alexander Knobloch, MD
Editor: Christian Fulmer, DO

Patient Presentation:
A 15-year-old male cross-country runner presented with exertional numbness, paresthesias, and skin color changes of his bilateral hands. The skin on his fingers would turn white, bluish purple, or red while on runs Case Photo #1 . He denied association with cold exposure. Symptoms began intermittently in the spring, but began to occur on every run with increasing workout intensity and distance during his fall season. Symptoms typically resolved after running, but could persist for hours after runs of increasing intensity or duration, with the numbness and paresthesias spreading up his forearms. He denied neck pain, rashes, fever, chills, night sweats, arthralgias, or prior trauma.

Physical Exam:
Slightly rounded shoulders while sitting, but no overt thoracic kyphosis. Corrects posture with cueing. Upper extremities show no skin discoloration, rashes or edema noted on bilateral hands/fingers. Capillary refill less than 2 seconds bilaterally. Two plus radial pulses. Normal sensation to light touch over the hands and fingers. Negative Tinel test at the cubital tunnels. Wright hyperabduction test reproduced numbness and paresthesias in the hands bilaterally, with subtly decreased radial pulses. Negative Adson's test bilaterally.

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