Pitcher's Pain - Usual Presentation Of Unusual Diagnosis - Page #1

Author: Andrew Swartz, MD
Co Author #1: Laura Owczarek, MD

Patient Presentation:
A 15 year-old right hand dominant high-level competitive female softball pitcher who presented with right forearm pain.

A 15 year-old right hand dominant high-level competitive female softball pitcher presented with right forearm pain for greater than one month duration. The pain was located at the anterior/medial aspect of the right forearm. It was described as a sharp, burning pain with numbness that radiated to her fourth and fifth digits. The pain was worse with any type of wrist movement, especially wrist flexion. She also reported pinpoint pain upon palpation of a localized area of her right forearm. The only treatments performed prior to her initial presentation included ice application and oral NSAID use with Aleve. She denied any trauma to the arm or any previous similar symptoms. She stated that she does practice softball and pitch year round and that she did obtain a new pitching coach just prior to the development of her current symptoms. She denied any significant changes in her pitching practice regimen.

Physical Exam:
On physical examination there was no noticeable erythema, warmth, open wound, or ecchymosis of the right forearm.
There was point tenderness to palpitation of the right forearm located 5cm proximal to the wrist along the ulna with visible and palpable swelling. There was no other areas of tenderness.
There was full active and passive range of motion at elbow, wrist and MTP/PIP/DIP joints.
Pain was elicited with resisted wrist extension and supination.
Varus and valgus stress at elbow was negative for any pain or laxity.
Cutaneous sensation was intact throughout.
Strength was 5/5 with resisted elbow and wrist flexion and extension.
Radial pulse was 2+.

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