Forearm Pain- Diving

Abstract

HISTORY: A 22 year old International and NCAA Division I female diver developed medial forearm pain during the Spring of 2017 experienced only during the pike position of her dive. The pain initially was during the activity only but progressed to pain after the activity had ended. PHYSICAL EXAM: The examination of the athlete was done in the athletic training room by a physical therapist. Subjectively, questions about female athlete triad indicated inconsistent menstrual cycle. However, she did consume adequate calories including foods with calcium and protein. Further questioning about hormone levels and nutrition indicated she had been found to have low levels of vitamin D in previous blood tests as well as very low estrogen. The athlete reported having to take estrogen supplements in the past. The physical exam revealed normal active range of motion bilaterally, normal sensation, reflexes, and strength. Vascular system was noted to be intact. Upper limb nerve tension was tested, resulting in negative findings. Pin point pain with palpation along the ulna in two places, one approximately middle of the ulna and the other approximately 2 inches from the proximal radioulnar joint, reproduced her pain. Applied manual force at each end of the ulna over a fulcrum also reproduced her pain suggesting an osseous pathology so imaging was suggested by the physical therapist and ordered by the orthopedic surgical fellow. DIFFERENTIAL DIAGNOSIS: Ulnar Stress Reaction 1. Periostitis 2. Bone Contusion TESTS AND RESULTS: Plain Radiographs demonstrate bowing of the ulna WORKING DIAGNOSIS: The final diagnosis was bowing of the ulna with a stress reaction. TREATMENT AND OUTCOMES: 1. Increase core strength in pike position in create a “tighter” pike throughout the pike position during dive. 2. Scapulothoracic strengthening to offload the forearm during the dive. 3. Diving Technique 4. Vitamin D supplements and nutrition counseling.