Hand Numbness in a Soccer Player

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HISTORY This is a 20 year-old male college soccer defenseman who developed hand numbness and weakness after an elbow injury during a soccer game. During the first half of the game he was kicked in the medial aspect of the left elbow and then fell to the ground. He does not remember the exact mechanism of injury. He initially felt numbness throughout the left 4th and 5th digits and was removed from play. He went back in for the second half and completed the game. He presented to the sports medicine clinic three days later at which time the numbness in the 4th and 5th digits remained unchanged. He denied numbness in the forearm as well as neurogenic pain. In addition he complained of weakness in the left 4th and fifth digits. Most notably he was not able to move his left 5th digit normally. He had been taking ibuprofen intermittently. PHYSICAL EXAMINATION Upon presentation in the sports medicine clinic three days later he had a mild to moderate deformity of the 4th and 5th digits of the left hand which included extension at the MCP joints and flexion of the PIP joints. There was no tenderness to palpation. There was decreased sensation to light touch and hyperesthesia to pinprick in the following distribution: dorsal and ventral aspect of the 4th and 5th digits, dorsal and ventral aspects of the medial palm and dorsal aspect of the forearm. Manual motor testing showed 4/5 strength with abduction of the 5th digit and 4th and 5th digit DIP flexion. Froments sign was positive. DIFFERENTIAL DIAGNOSIS Ulnar neuropathy Median neuropathy Brachial plexopathy Cervical radiculopathy TESTS AND RESULTS None FINAL WORKING DIAGNOSIS Traumatic ulnar neuropathy TREATMENT AND OUTCOMES The preservation of motor strength and hyperesthesia to pinprick were felt to be indicators of an incomplete injury and a likely good prognosis. Treatment included Vioxx 50mg PO QD to reduce swelling in the area of the ulnar groove along with splinting of the involved digits to reduce clawing in the 4th and 5th digits. With this treatment numbness and weakness resolved within two weeks and the claw deformity resolved by 3 weeks.