Author: Margaret Provencher, MD
Co Author #1: Margaret M Provencher, MD
Co Author #2: Kristopher Fayock, MD
Senior Editor: Heather Rainey, MD
Editor: Mehwish Moinuddin, DO

Patient Presentation:
A right hand dominant, 20 year old male Division 1 wrestler presented to Sports Medicine clinic with an acute left elbow injury sustained the day prior. During practice the dorsal aspect of his left hand and forearm were forcefully pinned to the mat, with his shoulder externally rotated and his elbow flexed. He felt a "pop" in his medial left elbow. He developed pain and had a brief episode of paresthesia affecting the fourth and fifth digits of his left hand for 1 minute. He had no further numbness or tingling after that brief episode. He was able to complete practice that day and iced the elbow after practice. His athletic trainer sent him for further evaluation when his pain persisted the following day. He has noticed a small amount of swelling without ecchymosis, but has not noticed any weakness, limitations in range of motion, or mechanical symptoms.

History:
He has no history of elbow surgery or prior elbow injuries. He has a history of growth hormone deficiency and is currently on growth hormone replacement therapy with somatropin. Per a visit with his endocrinologist, he has a current estimated bone age of 14 years according to standards of Greulich and Pyle from recent bone imaging.

Physical Exam:
Left Elbow Focused Exam: Symmetric muscle bulk in the bilateral upper extremities. Mild swelling noted over the medial aspect of the elbow. Active range of motion from 0 to 140 degrees, symmetric with the contralateral right elbow. Full range of motion in pronation and supination. Mild tenderness to palpation over the medial epicondyle and proximal aspect of the ulna. Negative Tinel's over the ulnar nerve. Negative biceps hook test. Mildly positive milking maneuver. Sensation intact to light touch throughout the median, radial, and ulnar nerve distributions. No pain with resisted wrist flexion or extension. No pain with resisted forearm supination or pronation. Full strength with elbow flexion and extension. 2+ radial pulses bilaterally.

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