Elbow Injury - Volleyball

Résumé fourni par la source

HISTORY: A 22-year-old right-hand dominant female volleyball player presented to Sports Medicine Clinic with 5 years of chronic right elbow pain. Her symptoms began after an elbow hyperextension injury while playing high school volleyball, but she did not have it formally evaluated at that time. Initially the pain was intermittent, but it worsened 2 months ago after another hyperextension injury during intramural volleyball. Activities such as folding clothes, lifting heavier objects, and pushing on her elbow amplified the pain. Rest and cradling her elbow improved the pain. She also reported intermittent “catching” of the elbow with flexion and extension. She denied numbness or tingling but did express occasional decreased grip strength in her right hand. PHYSICAL EXAMINATION: Overall, the patient was in no acute distress. Her neck was supple. On inspection of her right elbow, there was no soft tissue swelling, joint effusion or deformity of her right elbow. She was tender to palpation over the lateral joint line without tenderness to the remainder of the elbow or surrounding structures including her triceps and olecranon. She had full active and passive elbow flexion, extension, pronation, and supination, all without inducible pain. She had full strength in all planes of motion at the elbow joint. Her sensation was intact in the radial, ulnar, and median nerve distributions distally. DIFFERENTIAL DIAGNOSIS: 1.Osteochondral defect2.Osteochondritis dissecans3.Common extensor tendinopathy of the elbow4.Intra-articular loose body5.Olecranon compression overload6.Intra-articular mass TEST AND RESULTS:3 views right elbow radiographs (AP, lateral, oblique)-No acute osseous abnormality.-No substantial degenerative change.-No joint effusion. MRI Right Elbow without contrast-Thickened and edematous posterior lateral synovial fold as can be seen in elbow synovial fold syndrome. FINAL WORKING DIAGNOSIS: Elbow synovial fold syndrome TREATMENT AND OUTCOMES:1. Relative rest2. NSAIDs3. Referral to orthopedic surgery given prolonged symptoms for consideration of arthroscopy and resection of thickened synovial fold

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