Median Nerve Entrapmentin a High School Female Softball Player

By Ashlee Capano

History

• 15 yr old softball/clarient player• Athlete hurt elbow last softball season prior to entering

high school and never received treatment.• Upon assessment patient reported no mechanism of injury

this season but has gotten progressively worse over the past two weeks.

• Athlete reported radiculopathy into the third and fourth metacarpals and that her whole arm was cold all the time.

• Trouble playing clarinet, typing, and writing.• Athlete reported being awoken by sensations of

radiculopathy down the entire arm

Assessment• Inspection revealed no gross deformities, carrying angle

discrepencies,bruising, or signs of infection. • Athletes involved arm did appear to be paler than the uninvolved arm

with poor capillary refill.• Palpation revealed point tenderness over the medial epicondyle, UCL, and

olecranon process. • ROM of the elbow was painful in all planes with strength deficiets in

extension, pronation, and flexion.• ROM of the wrist was painful in all planes and there was a decrease in grip

strength.• ROM of the shoulder was WNL in all planes.• Dermatome /Myotome assessment revealed dificiencies in c5-c7 patterns.

Assessment Cont’d• None of the MMT were able to be held due to pain• Positive Special Tests

– Phallens– Tinel’s Sign– Valgus Stress Test 0/30 for laxity but have a firm end feel.– Delayed C6 reflex

Clinical Impression

• Median Nerve Impingement (Pronator Teres Syndrome) with a Grade I UCL sprain

• Physician Referral– Imaging

Pronator Teres Syndrome• Similar to carpal tunnel syndrome, pronator teres syndrome typically

squeezes the median nerve producing numbness or tingling in the palm, thumb, forefinger and middle finger

• Since the well-known condition of CTS also involves compression of the median nerve, many cases of PTS are mistakenly diagnosed as carpal tunnel syndrome.

Possible Treatment Options

• Conservative Treatment: Activity modification to Immobilization for 4-6 weeks depending on severity symptoms

• Operative Treatment: Decompression of all four sites of possible pathology

Rehabilitation• ROM- fingers, wrist, elbow, shoulder• Joint Mobilizations• Resistance Exercise• Maintain fitness level• Stretching• Flexibility• Core Strength• Scapular Stabilization