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Too Much Wrist: Progressive Forearm Pain In A Collegiate Fencer - Page #1
 

Author: Brooke Sciuto, MD
Co Author #1: Ryan Bart, DO
Senior Editor: Justin Mark Young, MD, FAMSSM
Editor: Blake Corcoran, MD, CAQSM

Patient Presentation:
An 18-year-old left hand dominant female collegiate fencer presented with 3 months of progressive left forearm pain associated with fencing activities.

History:
The athlete presented with 3 months of progressive left forearm pain localized approximately 4 centimeters distal to the lateral epicondyle with radiation in the radial nerve distribution. Symptoms worsened with fencing and improved with rest. Pain severity was rated 7 out of 10 during fencing, and 2 out of 10 at rest. She fenced 5 times weekly for 2.5-hour sessions using her left upper extremity as her weapon arm. She denied acute trauma, and had failed an initial rehabilitation program with her athletic trainer.

Past medical history was notable for similar but milder symptoms previously associated with increased training load. She denied prior upper extremity injury, disordered eating, menstrual irregularity, or other bone health risk factors.
Past medical history was notable for similar but milder symptoms previously associated with increased training load. She denied prior upper extremity injury, disordered eating, menstrual irregularity, or other bone health risk factors.

Physical Exam:
Left Elbow
Inspection: No erythema. Edema over the brachioradialis approximately 4 centimeters distal to the lateral epicondyle.
Palpation: Tenderness to palpation over the proximal radius and brachioradialis.
Range of Motion: Normal elbow and wrist range of motion.
Strength: Mildly decreased strength with wrist extension. Otherwise preserved upper extremity strength.
Neurovascular: Intact distally.
Special Testing: Positive Cozen test. Positive Maudsley test. Positive Tinel sign at the Arcade of Frohse. Negative Tinel sign at the cubital tunnel.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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