My daughter is a college pitcher who throws mostly curve and rise balls. Due to consistency problems her athletic trainer (A.T.) told her to quit running daily as he felt that it might be affecting her small muscles. She recently told me about "a little pain" in her hand. She has a high pain tolerance and thinks pain is part of pitching, so I'm not sure when it began. She saw the A.T. and he gave it a name (which she forgets) but did not send her to a doctor or do any tests. My daughter said the pain started with her ring finger, and then her palm and now the wrist. She is still pitching, although not very successfully lately. In 9th grade she had cartilage damage to her wrist that wasn't diagnosed in time to repair correctly. In 11th she had stress fractures that she did not complain about until she also developed tendonitis. The fracture wasn't diagnosed until it became a break. Now I'm afraid A.T. might be overlooking what might be or could become a serious injury. Her pitching performace has never reached pre-injury levels which I had attributed to other factors. Would cartilage damage to the wrist or ulna fracture/break make her more susceptible to ulna nerve problems? Is there any test she could do to determine if it is the ulna nerve? Lastly, could continuing to pitch make things worse?
Last Edit: Apr 12, 2011 15:09:43 GMT -6 by h20pools
Post by Mark Gibbs, MD on Apr 15, 2011 9:14:33 GMT -6
Dear softball pitcher's parent, I am sorry to hear of the problems your daughter is having during her current softball season. Given the history that you described in your posting, it is difficut to determine what is actually going on with her without seeing her and performing an examination. The ulnar nerve can certainly cause symptoms in the upper extremity and generally affects the ring and small fingers from a sensory standpoint but can cause a variety of motor symptoms as well. It can be pathologic in several locations including the neck, elbow, and wrist. In response to your several questions at the end of your posting: 1. Fractures about the wrist can predispose one to ulnar nerve symptoms if the nerve is impinged secondary to deformity or exuberant fracture callus 2. Physical examination with the addition of radiography and/or electromyographic and nerve conduction velocity studies can be used to diagnose ulnar nerve problems 3. As for pitching, difficult to say if it could make the problem worse without knowing exactly what the problem is.
Bottomline: I would certainly recommend having your daughter evaluated by an orthopedic surgeon in your area to determing the best course of diagnostic and treatment options.
Mark B. Gibbs, MD Sports Medicine Orthopedic Surgery Fellow American Sports Medicine Institute Birmingham, AL
Thank you for the replies. I think she is just being seen by the school doctor. They haven't done any diagnostic tests. The doctor put her on oral steroids and said they will make further decisions based on her response to that. I would feel much better if she is seen by someone more knowledgeable. She goes to school near Chattanooga, TN and we live in Huntsville, AL, so I can take her to someone in either place. Thanks again.
The school doctor had put her on oral steroids for 5 days but not only is she not better but the pain has advanced to her elbow. He is going to make her an appointment with a hand specialist. Can you recommend someone in the Chattanooga area? Thank you.
Dr. Gibbs and Dr. Feisig - I wanted to thank you and give you an update. An MRI and a Nerve Conduction test revealed two torn ligaments and ulna nerve compression at Guyon's canal. We think she tore the ligament trying to compensate for the control issues caused by the nerve impingement. The surgeon felt it was best to forego repairing the ligaments. He said the faster he could get in and out, the faster the recovery. He said the length of recuperation and amount of recovery depended on how long it had been impinged, which may have been a fairly long time. She went through the surgery fine and has very little pain at the incision point, so we are prayerfully anticipating 100% restoration. Thanks again for your help
Doing research and came across your post. This sounds like what my daughter is exactly going through right now as a college pitcher. Just wanting to know what was the long term effect for your daughter since it was so long ago? Was she able to restore and continue pitching?