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Looking Further When Symptoms Are Disproportionate to Physical Findings

SHRIER, IAN1; MORRISON, DAVID R.1; HAWKES, ROGER2

Medicine & Science in Sports & Exercise: January 2019 - Volume 51 - Issue 1 - p 1–3
doi: 10.1249/MSS.0000000000001744
CLINICAL SCIENCES

ABSTRACT A 36-yr-old man presents with left ulnar-side wrist pain during an ice hockey game that prevented him from playing hockey or golf. There was no acute mechanism of injury. The usual clinical examination revealed only minimal tenderness and minimal pain with resisted wrist extension. Careful attention to precipitating factors led to testing resisted wrist extension with the forearm fully supinated, which reliably reproduced the intensity of the patient’s symptoms, and a diagnosis of extensor carpi ulnaris tendinopathy. A literature review suggested three additional special tests (two were positive) and management. However, a standard of care has yet been established because neither the tests nor the management has been properly validated through research, thus leaving the management of this condition as an art.

1Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, CANADA; and

2European Tour Performance Institute, European Tour, UNITED KINGDOM

Address for correspondence: Ian Shrier, M.D., Ph.D., Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital 3755 Cote Sainte-Catherine Road Montreal, QC Canada H3T 1E2; E-mail: ian.shrier@mcgill.ca.

Submitted for publication March 2018.

Accepted for publication July 2018.

© 2019 American College of Sports Medicine