Finding A Sense Of Humor: Arm Pain In A Tennis Player

HISTORY: 21 yo. male tennis player presenting to training room with R arm pain for several months. No specific injury but increase in training over the summer with little recovery. He notes that the pain started during this increase in training and improved with OTC medication. However, the pain has returned and is not improving with previous measures. The pain is located in the R posterior arm and triceps, it is achy with occasional numbness/tingling into arm and hand. No neck or shoulder pain. It is worse with playing tennis, specifically with serving and forehand strokes. He has tried work with athletic trainer, rest, ice, and anti-inflammatories. PHYSICAL EXAMINATION: NAD Non-antalgic gait No ecchymosis/effusion/swelling TTP R posterior arm over triceps muscle, midportion humerus FROM t/o, Restricted end range of shoulder external rotation bilaterally 5/5 strength t/o Normal tone and bulk Negative Hawkin's, neer, empty can, speeds, obrien's tests bilaterally Negative Allens, Roos, Adson test Sensation intact t/o DIFFERENTIAL DIAGNOSIS: 1. Triceps tendonitis 2. Triceps brachii contusion vs overuse injury 3. Thoracic Outlet Syndrome 4. Cervical radiculopathy 5. Stress injury to humerus TEST AND RESULTS: C-spine XR: Straightening of the cervical spine. No acute abnormality. No foraminal stenosis. No significant degeneration. Probably old fracture of the spinous process of T1. Clinical correlation.XR humerus: (show image)MRI humerus: (show image) FINAL WORKING DIAGNOSIS: Stress Fracture of the Humerus TREATMENT AND OUTCOMES: - The patient continued to follow up with sports medicine and recommended: - Reduced humeral loading for 4-6 weeks - No tennis or upper extrem. Lifting for 4-6 weeks - OK for shoulder and ROM movements - OK to work lower body About 1 week in to starting rehab with his athletic trainer, working on end range scapular stability, thoracic rotation, and cervical stability without resistance, the patient endorsed about 95% improvement in pain with ADLs.