Author: Nathan Krug, MD
Co Author #1: Dr. Andrew Porter, D.O.
Co Author #2: None
Co Author #3: None

Patient Presentation:
A 21 year-old, right-handed, female, collegiate softball pitcher presented with complaints of right forearm pain as well as numbness in her entire hand for the past 1-2 weeks.

History:
Her symptoms began insidiously during the spring softball season. Pain was primarily along the medial elbow and into the flexors of her wrist. Numbness and pain would occur after throwing for several innings. She described the numbness as generalized to her right hand involving all fingers but worse in the ring and small fingers. Her forearm also felt full and heavy. Symptoms were significantly exacerbated by overhead throwing, brushing hair, or doing any overhead activities. Pain would occasionally wake her up at night if she slept with her hands overhead. She had no history of similar symptoms or right arm/shoulder injury.

Physical Exam:
General: healthy appearing female, protracted shoulder posture bilaterally.

Neck: Full pain-free range of motion, non-tender to palpation over cervical spine, interscalene triangle, sternocleidomastoid, clavicle, and coracoid process. No mass in supraclavicular fossa bilaterally.

Right Shoulder: Full pain-free range of motion, non-tender, rotator cuff strength 5/5, scapulothoracic dyskinesia noted. No swelling in right upper arm.

Right Elbow: Tenderness to palpation over the medial epicondyle and common flexor tendon, No pain or laxity with valgus stress at 0 and 15 degrees at the Ulnar Collateral Ligament. Negative milking maneuver & moving valgus stress test.

Right Forearm: moderate swelling and muscle fullness noted throughout the forearm, sensation intact.

Right Wrist/Hand: Pain with resisted wrist flexion over medial elbow, grip strength 5/5, sensation intact over dorsal and volar aspects of the hand and all fingers.

Special Tests: Roos test and Adson’s maneuver both illicited loss of the right radial artery pulse and patient reported hand numbness, forearm fullness, and pain over the medial elbow.

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