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22b - Answer: 15-year-old male presents with ulnar pain in left forearm

Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
Includes DICOM files

HISTORY: 

This 15-year-old male presents with ulnar pain in left forearm. Tennis player with pain when hitting backhand. Evaluate for stress phenomenon or injury.

(QUIZ ANSWER) GRADE CAN BE RULED OUT: 

Grade 4.

Using the diagnostic web viewer, we have provided images that assist in telling our clinical story. Areas of significance are indicated below.

FINDINGS:

Although the pattern is unusual, a stress phenomenon is identified in the posterior aspect of the ulnar shaft and would correlate with the patient's clinical syndrome. 

In grading the stress injury, the grade would be 2-3 out of 4 as there is no discrete stress fracture or completed stress fracture line at this juncture. 

The surrounding soft tissues are normal other than mild periostitis. 

The interosseous space is normal. 

No compartment syndrome is noted. 

Biceps, triceps and brachialis are intact. 

CONCLUSION: 

Class 2-3 out of 4 stress phenomenon of the ulna in a tennis player. No completed stress fracture or grade 4 stress phenomenon is noted at this juncture.

LESSON 2, TOPIC 66

Case Challenge: Forearm MRI Cases

Case Challenge

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Content reviewed: July 19, 2021

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