Misdiagnosis Of Ulnar Nerve Compression And Entrapment In Rock Climbing: A Case Series

History: A 28-year-old male climber presented with chronic bilateral medial elbow pain, received 29 physical therapy sessions and multiple corticosteroid injections over 2 years without improvement. Similarly, a 29-year-old female climber presumed medial epicondylitis presented with severe symptom onset within 30 minutes of climbing despite extensive physical therapy preventing continuation of activity. Lastly, a 51-year-old male climber self-diagnosed as medial epicondylitis for two years presented with diffuse medial arm symptoms. Physical Examination: Regional medial elbow tenderness noted in each athlete, with a report of increased pain upon general use of the upper extremity. Pain with elbow flexion and manual muscle testing of the forearm. Weakness in pinching and gripping and overall grip strength. Symptom reproduction with climbing positions, holds, and climbing-specific upper extremity loading, with radiation of pain and paresthesias into the forearm. Differential Diagnosis: 1.Medial Epicondylitis 2.Ulnar Neuropathy 3.Pronator Syndrome 4.Ulnar Collateral Ligament Sprain 5.Cervical Radiculopathy 6.Brachial Plexopathy Tests and Results: Positive upper limit neurodynamic tests of the ulnar nerve to reproduce symptoms, pain with elbow flexion test, positive Tinel’s at the ulnar nerve, and asymmetry with flexor/extensor strength ratios were noted. Final Working Diagnosis: Ulnar neuropathy at the elbow in all three cases Treatment and Outcomes: 1. Nerve mobility-based treatment initiated including tensioning, flossing and gliding techniques. 2.Within 2-3 weeks all three athletes returned to climbing without pain or fear of reinjury. 3.These cases highlight the detrimental impact of delayed or misdiagnosed ulnar neuropathy in climbers, resulting in prolonged absence from sport, decreased performance, and psychological distress. Our series revealed diagnostic delays, negative psychological impacts, and unnecessary interventions, posing potential side effects. Accurate diagnosis and focused treatment facilitated return to sport. 4.Elbow pain in climbers is commonly ascribed to medial epicondylitis. Nerve compression and entrapment can be overlooked and underdiagnosed in climbers even though aspects of climbing (e.g. sustained elbow flexion) are conducive to such pathology.