median nerve entrapment in a high school female softball player n.
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Median Nerve Entrapment in 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.

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Presentation Transcript
history
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
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
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
Clinical Impression
  • Median Nerve Impingement (PronatorTeres Syndrome) with a Grade I UCL sprain
  • Physician Referral
    • Imaging
pronator teres syndrome
PronatorTeres Syndrome
  • Similar to carpal tunnel syndrome, pronatorteres 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
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
Rehabilitation
  • ROM- fingers, wrist, elbow, shoulder
  • Joint Mobilizations
  • Resistance Exercise
  • Maintain fitness level
  • Stretching
  • Flexibility
  • Core Strength
  • Scapular Stabilization