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19-YEAR-OLD GIRL WITH RIGHT FOREARM PAIN
Authored By: Keith Fischer and Asif Moinuddin.
Patient: 19 year old female
History: Right forearm pain in a right handed softball pitcher
Image Size:[small][as-submitted]

Fig. 1
Immediate static bone scintigraphy images of the forearms

Fig. 2
2.5 hour delayed images of the upper extremities with a lateral view of the right arm
Image Size:[small][as-submitted]

Findings: RADIOPHARMACEUTICAL: 21.3 mCi Tc-99m MDP i.v.
 
FINDINGS:
A limited examination of the bilateral forearms demonstrates linear increased uptake  along the right proximal ulnar diaphysis on both the immediate (Fig 1) and delayed (Fig 2) bone scintigraphy images.  No focal uptake is noted to suggest a stress fracture.  A normal distribution of activity is present in the left forearm.
DDx: Stress fractures, forearm "splints" ( analogous to shin splints)
Diagnosis: DIAGNOSIS: "Forearm Splints"
General Discussion: FULL HISTORY:
19-year-old softball pitcher with right forearm pain. Evaluate for stress fracture

DISCUSSION:
Lateral periostitis along the proximal right ulnar diaphysis representing stress reaction at the origin of the flexor digitorum profundus muscle compatible with "forearm splints." This has been sited as an arm injury in weight lifters and hockey players*.  It would seem likely that the repetitive action of pitching may also produce this injury.
References: *Reference:
The American Journal of Sports Medicine 28:746-747 (2000)
Comments:
No comments posted.
Additional Details:

Case Number: 90532Owner(s): Keith Fischer and Asif MoinuddinLast Updated: 02-07-2013
Anatomy: Skeletal System   Pathology: Trauma
Modality: Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: bsnm, splints, periostitis, fractureACR: 40000.41940

Case has been viewed 64 times.
Certified by Keith Fischer on 01-27-2009

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