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History:No known injury. Intermittent, dull, radiating. Starting at the shoulder and moving to the medial elbow, but sometimes only at the medial elbow with numbness of the 4th/5th digits. No limitations in ballet. Extended course to see Sports Medicine. PCP - failed treatment for herpetic whitlow, referred to dermatology. Dermatology - bilateral Raynaud's syndrome & Pernio, referred to rheumatology. Rheumatology - having RUE numbness, referred to neurology & PT. Neurology - tenderness to palpation at the anterior shoulder, referred to Sports Medicine. PT - getting stronger, but symptomatically making minimal improvement. PE:Cardiac: capillary refill normal. MSK: RUE: Inspection: No erythema, edema, or bruising. Lower trapezius wasting visible when examining back/scapula. Palpation: Tenderness at medial epicondyle but not same pain she has previously experienced. No tenderness to palpation throughout remainder of RUE. ROM: Full ROM without pain or numbness. Strength: Normal strength. Special Tests: Spurling's negative, Roos negative, Adson's positive with loss of palpable radial pulse. Differential:Thoracic Outlet Syndrome, Cervical Neuropathy, Right Shoulder Tendinopathy, Scapular Dyskinesia, Medial Epicondylitis. Discussion:Initial presentation was interesting with overall non-specific symptoms and many specialists who had new findings, including bilateral Raynaud's syndrome. Patient was unable to truly localize if the pain was from her neck, shoulder, or elbow, but endorsed pain at times in all these locations and had no symptoms on day of clinic visit. It wasn't until the positive Adson's test that the diagnosis started to become clearer, or at least moved thoracic outlet syndrome to the top of the differential diagnosis. Concern for thoracic outlet syndrome guided further management.


Orthopedics | Pediatrics | Sports Medicine


Presented at the 2022 American Medical Society for Sports Medicine Annual Meeting; Austin, TX; April 8-13, 2022.

17-year-old ballet dancer with 4 years of right upper extremity pain