BILATERAL FOREARM AND HAND PAIN IN WEIGHTLIFTER

Abstract

531 HISTORY - A 36-year-old amateur weight lifter complained of a 18 to 24 month history of bilateral elbow and hand pain. The pain started after he initiated a program of lifting heavy weights, twice a day, two years ago. He described the pain as soreness on the lateral aspects of his elbows. He denied bilateral wrist extension weakness and night pain. As a shipping and receiving clerk, his occupational duties exacerbate his symptoms. Taking 200mg of lbuprofen three times per day has not helped. In addition, he also described bilateral hand numbness and tingling, which started two weeks prior to his appointment. PHYSICAL EXAMINATION - Examination revealed a mesomorphic individual with normal cervical active and passive range of motion. Spurling's and Lhermitte's signs were negative. Strength, sensation and reflexes were normal bilaterally. Tinel's sign was positive, but Phalen's test was negative at the wrists bilaterally. Palpation over the epicondyles bilaterally did not reproduce tenderness; however, resisted metacarpophalangeal extension did reproduce the elbow pain. DIFFERENTIAL DIAGNOSIS: Bilateral epicondylitis Bilateral carpal tunnel syndrome Bilateral posterior interosseous nerve entrapment TESTS AND RESULTS: Lateral epicondyle corticosteroid injection exacerbated the pain. Elbow and wrist xrays were negative. Electrodiagnostic testing ruled out bilateral carpal tunnel syndrome. It did show bilateral fibrillation potentials in the extensor indicis, which was consistent with posterior interosseous syndrome. FINAL/WORKING DIAGNOSIS: Bilateral posterior interosseous nerve entrapment TREATMENT: Relative rest with the discontinuation of weight lifting. Increase NSAIDs to therapeutic dose. Splint elbows to 90 degrees of flexion. Follow up EMG/NCT indicated resolution of the active denervation.