Exercise Induced Swelling And Neurologic Symptoms-Women's Lacrosse

Abstract

HISTORY: 21year-old female freshman college lacrosse player, with pmh of right shoulder multi-directional instability secondary to Ehlers-Danolos, presents with a three week history of right arm swelling, discoloration, and numbness during jogging. Starting in fall 2009, the patient complained of right arm swelling, numbness, and pallor during jogging. The patient could feel her right shoulder subluxing while jogging. After jogging for 15 minutes she would start having numbness and tingling in her arm. She also noted hand swelling and discoloration. The patient was evaluated with right shoulder instability during her pre-participation physical examination. She failed a rehabilitation program so underwent an arthroscopic capsulorrhapy and Bankart repair of the anterior and posterior labrum during her sophomore year. She continued to have multiple subluxations. A consulting orthopedic surgeon determined that her shoulder laxity was secondary to Ehlers-Danlos. She was tested by a geneticist who confirmed the diagnosis. PHYSICAL EXAM: Mild tenderness of the anterior and posterior capsule. Positive sulcus sign bilaterally. Equal radial and brachial pulses. No peripheral arm edema. Nor No peripheral arm edema. Normal skin color and temperature. Strength of the upper extremity 5/5. Sensation to pinprick intact. Biceps, triceps, and brachioradialis reflexes 2+. DIFFERENTIAL DIAGNOSIS: Complex regional pain syndrome Axillary artery aneurysm or occlusion Tumor (mass effect) Raynaud's phenomenon Vascular etiology-arterial/venous/mixed TESTS AND RESULTS: Segmental wrist brachial index: Left and right arm is normal. Upper Extremity Thoracic Outlet Study: Abnormal during 7 lb weight maneuver in the right extremity. The left extremity is normal. FINAL WORKING DIAGNOSIS: Exercise induced thoracic outlet syndrome TREATMENT AND OUTCOMES: Patient was cleared to play given the understanding that participating in lacrosse has the risk of recurrent right shoulder subluxations, long term nerve injury to the brachial plexus, and vascular injury because of repetitive damage. Physical therapy for shoulder girdle strengthening