Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with chronic, aching pain localized to the proximal-lateral aspect of the left forearm, distal to the lateral epicondyle. Symptoms are exacerbated by repetitive forearm pronation, wrist flexion, and elbow extension. Patient denies sensory deficits or nocturnal paresthesias. No history of acute trauma.
Clinical Examination Findings
Left upper extremity examination reveals focal tenderness to palpation over the radial tunnel, approximately 3-4 cm distal to the lateral epicondyle. Resisted supination of the forearm and resisted extension of the middle finger (Maudsleyโs test) reproduce the patient's characteristic pain. No motor weakness of the extensor digitorum communis or extensor carpi ulnaris noted. Tinelโs sign negative at the elbow.
Treatment Protocol
Conservative management initiated including activity modification to avoid repetitive forearm rotation, prescription of NSAIDs, and a trial of physical therapy focusing on nerve gliding exercises and ergonomic adjustments. Splinting in a neutral position may be utilized for symptomatic relief. Follow-up in 6 weeks to assess for clinical improvement.