Supracondylar process syndrome: A case report

Abstract

A 43-year-old right-hand-dominant female licensed practical nurse presented with a 10-year history of pain and paresthesias involving the left forearm. Her symptoms had become progressively worse and were exacerbated by distributing medicine to patients and repeatedly opening unit dose packages. She reported waking up several times each night because of an inability to find a comfortable position for her left forearm. Examination of the left forearm revealed diffuse tenderness. Light palpation 8 cm proximal to the medial epicondyle produced median and ulnar nerve paresthesias in the distal forearm and hand. Tinel's sign was positive over the carpal tunnel but not over Guyon's canal. Phalen's test was positive. Pinch was weak, as were the intrinsic hand muscles. The pronator teres muscle was tender. Pronation with the elbow flexed produced paresthesias in the median nerve distribution with the sensation that the fingers were cold. Supination and flexion decreased these symptoms, but the patient was most comfortable with the forearm held in a neutral position of rotation. Extension in supination caused pain along the ulnar forearm, whereas extension with pronation caused pain along the radial border of the forearm. Simple pronation and supination produced claudicatory pain in the forearm and hand within a few seconds.