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- W4294796398 abstract "History: A 22 y.o. male with a history of ulnar collateral ligament reconstruction and right elbow ulnar decompression a year prior presented for follow up with persistent shoulder soreness. He was collegiate pitcher and after 18 months post op, he started to experience vague anterior shoulder/upper arm pain and numbness down the arm. He had some difficulty localizing the symptoms. He was clinically diagnosed with TOS and initial recommendations included physical therapy, changing pitching biomechanics, pitch count limits and an interval throwing program. Physical Exam: On physical exam, he had full ROM for his shoulder, no tenderness around the ulnar collateral ligament. He had tenderness around the muscular tendinous junction of the long head of the biceps and anterior proximal humerus. He also had irritation around the volar forearm. He had positive signs of impingement and Roos test, but no vascular changes with position changes and stretching of the brachial plexus. Differential Diagnosis:- Acromioclavicular Joint Injury- Rotator Cuff Tear- Shoulder Instability Test and Results:Right shoulder MRI was significant for anterior tendinosis of the supraspinatus with signal changes in the labrum consistent of him throwing. However, pain did not improve and MRI of the brachial plexus with Thoracic Outlet syndrome technique, which confirmed TOS with isolated musculocutaneous neuropathy. Electromyography testing showed right sided variable SNAP configuration with mildly prolonged latency and reduced amplitudes confirming brachial plexopathy (TOS) but also showed a superimposed musculocutaneous neuropathy Final Diagnosis:Thoracic Outlet Syndrome with superimposed musculocutaneous neuropathy Treatment outcomes: -Initially conservative treatment with limited throwing regimen with changes in pitching biomechanics. Also, referred to physical therapy and prescribed Voltaren Gel. Symptoms progressively worsening-Then treated more aggressively with activity modification and therapy, along with education and counseling regarding TOS and musculocutaneous neuropathy. His musculocutaneous neuropathy symptoms improved, but TOS symptoms continued-Patient returned to pitching, but considering TOS surgeon consultation" @default.
- W4294796398 created "2022-09-06" @default.
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- W4294796398 date "2022-09-01" @default.
- W4294796398 modified "2023-09-27" @default.
- W4294796398 title "Rare Case Of Simultaneous Thoracic Outlet Syndrome And Musculocutaneous Neuropathy In A Baseball Pitcher" @default.
- W4294796398 doi "https://doi.org/10.1249/01.mss.0000879580.19122.02" @default.
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