Forearm Injury-Softball

Abstract

0618 HISTORY: A 16-year-old right-hand dominant softball pitcher presented for evaluation of a red forearm after a three-week holiday from pitching. Six months prior to presentation, she began to develop right medial volar forearm redness and pain with pitching that dissipated after changing her pitching technique. Throwing three to four pitches reproduced this redness and pain which worsened if she continued pitching. Cessation of pitching and application of ice relieved her symptoms within 20 minutes. She denied swelling, numbness, tingling, or temperature change at rest or with activity. Past medical history, review of systems and family history were unremarkable. PHYSICAL EXAMINATION: Her right forearm was slightly more developed that her left. There was no venous engorgement, ecchymosis, discoloration, rash or mass. There was no pain with forearm palpation. She had full ROM and strength of the entire right upper extremity. A 2+ radial pulse was present. Adson's and Wright's maneuvers were negative. Temperature and sensation were normal. After 3 to 4 pitches, a faint erythematous reticular rash appeared over the right medial volar forearm with some mild pain. Symptoms resolved within 5 minutes of cessation of throwing. DIFFERENTIAL DIAGNOSIS: Exertional Thrombosis Chronic Compartment Syndrome Thoracic Outlet Syndrome Tendonitis Stress Fracture Autoimmune Disease TEST AND RESULTS: Forearm AP and lateral radiographs: Negative for fracture, soft tissue swelling, or bony deformity Doppler Ultrasound: Negative for upper extremity deep venous thrombosis Venogram of the right upper extremity Negative for thrombosis or thoracic outlet syndrome Forearm Volar Compartment Testing Elevated resting pressure of 38 mmHg in the right volar forearm FINAL WORKING DIAGNOSIS: Chronic right upper extremity volar compartment syndrome TREATMENT AND OUTCOMES: Fasciectomy of the superficial volar compartment overlying the fiexor carpi ulnaris, flexor carpi radialis, and palmaris longus. Longitudinal posteriorlateral and medial elliptical excisions were made to over 80% of the circumference of the muscle fascia. Wrist flexion/extension exercises and light weight work 2 weeks post-surgery. Return to basketball 1-month post-surgery. Pitching pain-free 2 months post-surgery. Pitching without difficulty at 1 year follow-up.