August 15, 2013
Numbness is among the most difficult problems for a physician to evaluate. It is an equally daunting task in sports medicine.
The vagueness of the complaint makes numbness a challenge to assess. It can represent sensory loss or distortions of sensation like “pins and needles,” “burning” and “crawling.”
A 23-year-old, left-handed pitcher presented with a chief complaint of left hand numbness. His symptoms included an “electrical shock” sensation that radiated from his elbow to the fourth and fifth digits of his left hand. His symptoms only came on when throwing a “change up.”
After further questioning, he has a unique throwing motion when finishing this pitch that places an unusual amount of torque on his elbow.
A neurological examination combined with electrodiagnostic testing demonstrated that he was suffering from an injury to the ulnar nerve at the elbow.
The ulnar nerve originates from the cervical nerve roots, proceeds down the arm and over the extensor surface of the elbow before terminating in the fourth and fifth digits of the hand.
It is the only nerve positioned over an extensor surface where it is vulnerable to pressure as opposed to other nerves that are located on more protected flexor surfaces.
Most people have experienced temporary ulnar sensory symptoms when hitting their “funny bone.”
Nerve injuries can result from mild compression, more severe prolonged compression or complete severing of the nerve.
The pitcher noted above improved with rest, physical therapy and changing his throwing mechanics. Sometimes athletes who ignore their early symptoms often require surgery to remove scar tissue or move the nerve to the flexor surface.
This case demonstrates the need for some detective work when dealing with vague complaints. A patient who carefully observes actions that worsen or improve a condition can expedite a correct diagnosis and early recovery.