A 60 year old right handed male recreational golfer injured his left wrist and hand two months ago while hitting an iron shot out of very tall grass. He tried to swing as hard as he could but his club was stopped abruptly in the grass after ball contact. He was able to complete the round of golf, although with pain and had difficulty gripping his clubs. He had been referred by his primary care physician to sports medicine due to persistent pain, localized to the ulnar aspect of his wrist and hand. Often times the pain seemed to radiate from the ulnar side of the wrist to the ulnar aspect of the hand. He denied any swelling, ecchymosis, numbness, paraesthesias, or loss of motion. He had self-treated with some rest, canceling many golf rounds, although he did try to play on occasion, but always with pain. He would take ibuprofen 200 mg 2 – 4 tablets up to three times a day. Denied any prior hand or wrist injuries.

PMH:
Hypothyroidism
GERD

MEDS:
Synthroid
Nexium
Ibuprofen

He had full range of motion of his wrist and hand.
Pain with ulnar deviation of wrist.
Strength symmetric except for decrease grip and ulnar deviation 4/5 of left wrist and hand. No swelling, errythema or ecchymosis
Tenderness over ulnar aspect of wrist but not in hand.
Negative Tinel’s sign at ulnar tunnel wrist.
X-rays of hand obtained by primary care physician were negative.

Initial Differential Diagnosis Based on the History and Physical: