Author: Viridiana Saenz, MD
Co Author #1: Michael Israel, MD
Senior Editor: Heather Rainey, MD
Editor: Nicole Prendergast, MD

Patient Presentation:
A 14-year-old female tennis player reported recurrent dorsal forearm pain and swelling aggravated during tennis strokes. Initial conservative management with counterforce bracing and non-steroidal anti-inflammatory medications (NSAIDs) yielded limited relief.

History:
A 14-year-old competitive female tennis player presented with recurrent pain and swelling of the right forearm after a significant increase in weight and tennis training. The pain localized to the dorsal aspect of the proximal forearm, initially occurred with backhand strokes and resolved with rest. The patient had not been able to practice tennis for a week, had minimal improvement with elastic bandage placement and pain was easily provoked with daily use of the right upper extremity, including typing. The patient denied paresthesias. She also noted the initiation of treatment for Crohn's disease. At the initial visit, the patient was started on conservative management with rest from practice, elastic bandage wrapping, NSAIDs and home exercises for forearm stretching. Four weeks later, the patient noted improvement of pain and was allowed to gradually return to practice. Initially, she tolerated practice without pain, however eight weeks later had recurrence of right forearm pain after a match. On representation, the pain increased in severity, was sharp and radiated down to the thumb. It was reproduced with any swinging motion and lasted up to a full day despite activity cessation. There was no associated numbness or paresthesias.

Physical Exam:
Mild to moderate soft tissue swelling of right lateral proximal forearm with associated tenderness to palpation of the brachioradialis. No elbow effusion. Full and symmetric range of motion, no laxity. Pain provoked with active wrist extension. Sensation grossly intact, pulses 2+, 5/5 strength of elbow flexion and extension, forearm pronation and supination, hand grip bilaterally.

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