Bilateral Arm Pain in a Male Cheerleader and Weight Lifter

Abstract

HISTROTY: A 20 year-old college male rugby player, cheerleader, and weight lifter presented to the sports medicine clinic with gradual onset of bilateral upper extremity pain during workouts. Pain was present for 3 to 4 weeks prior to presentation in the clinic and was described as “deep”, primarily located between his biceps and triceps in the middle one-third of his humerus. The pain did not radiate proximally or distally, and was present with bicep curls, tricep extensions, and cheerleading activities, especially overhead lifting. Pain lasted up to two hours after activities and then subsided. He denied specific injury and had no numbness or tingling. He had similar episodes in the past, but all had passed spontaneously. PHYSICAL EXAMINATION: A well appearing young man. Inspection of shoulders showed muscle symmetry with full range of motion. He had mild tenderness to palpation of the brachioradialis bilaterally and the humeral mid-shaft medially between the muscle bellies of the biceps and triceps. Upper extremity strength was full and symmetric. Neurological exam was normal. DIFFERENTIAL DIAGNOSIS: Brachioradialis strain Biceps/Triceps strain or tendonitis Humeral stress fracture TEST AND RESULTS: Plain radiographs of the left and right humerus were normal without fracture, periosteal reaction, or cortical defect. There were ill-defined densities in the right AC joint. MRI performed of the left upper arm showed bone marrow edema consistent with stress reaction without stress fracture, and no soft tissue edema. Subsequent whole body bone scan performed 3 weeks after cessation of upper body weight bearing activities showed focal uptake in the right AC joint, but was otherwise unremarkable. FINAL WORKING DIAGNOSIS: Bilateral humeral stress reaction. TREATMENT AND OUTCOMES: Recommend relative rest and avoidance of heavy upper extremity weight lifting, overhead lifting and tumbling activities until pain subsides. Once pain subsides the patient may gradually resume all activities as tolerated. The patient modified some of his upper body weight bearing activities but continued competing in cheering competitions. His symptoms gradually improved over the next 2 to 3 months. He continues weight lifting 5 days per week and cheerleading one day per week, with only minimal occasional discomfort.