Author: Ashkan Alkhamisi, MD
Co Author #1: James Moeller, MD
Senior Editor: Carolyn Landsberg, MD
Editor: James Toldi, DO

Patient Presentation:
A 15 year-old male presents with left arm pain for over one year.

History:
The athlete is a left hand dominant competitive tennis player, and although this pain had been present for over one year, it had worsened over the last 2-3 weeks prior to presentation. He does not recall any injury or trauma to the area. Pain is present during tennis activities, but he reports no pain at rest. The pain is throbbing in nature and located in the left upper and lateral arm. He denies any loss of grip strength, swelling, ecchymosis, numbness, tingling, or weakness of left upper extremity. He tried over the counter pain medications and icing with mild pain relief. Patient denies fever, chills, or night sweats, but endorsed muscle aches without associated weakness. He has no known prior left arm, shoulder, or C-Spine injury or developmental disorder. There is no significant past medical or family history.

Physical Exam:
On physical exam, he was afebrile with stable vital signs and appeared in no distress. He had a normal cardiac and pulmonary exam. Cervical spine exam elicited normal active range of motion without pain. Palpatory examination revealed soft, compressible compartments in the upper arm and forearm, no tenderness to palpation over the triceps or posterior upper arm, but positive palpatory tenderness over the proximal and middle humerus. Left shoulder range of motion was full in abduction, forward flexion, internal rotation, external rotation. Left elbow range of motion was full and painless. Left hand and wrist range of motion was full. He had full strength in wrist flexion, extension, and grip. Full strength in elbow supination, pronation, flexion, and extension. The left shoulder exhibited full strength in internal rotation, wtih abduction, forward flexion, and external rotation exhibiting decreased strength. The rest of his shoulder exam was unremarkable, with intact sensation to light touch. Neurovascular exam was unremarkable.

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