Disclosures: Millicent A Schratz, DO: Nothing to disclose

Case Description: 23-year-old male, without PMH, presented with right wrist drop x 7 days, numbness/tingling and pain. He experienced sudden onset of symptoms during police cadet circuit training involving tricep dips and push-ups. Since symptom onset, the patient has been unable to complete cadet training.

Setting: Physical Medicine & Rehabilitation outpatient clinic

Patient: 23-year-old male

Assessment/Results : EMG 1 week after onset consistent with right radial neuropathy. Ultrasound evaluation at 3 weeks demonstrated pathological appearance of right radial nerve proximal to and within the spinal groove. EMG at 5 weeks confirmed right radial neuropathy, proximal to brachioradialis innervation, with axon loss. He reported mild symptoms on the left, EMG revealing left radial neuropathy/posterior interosseous neuropathy with mild axon loss. At that time, weakness slightly improved with persistent dysesthesias. Non-operative management included: work restrictions, wrist bracing, and physical therapy. At 2-month follow-up, pain persisted, strength slowly improved. At 1-year follow up, left-sided symptoms resolved. Pain and occasional activity-related dysesthesias remained on the right, with mild weakness in wrist extensors.

Discussion: To our knowledge, this is the first case confirming bilateral radial neuropathy on both EMG and ultrasound. Studies suggest this area may be susceptible due to lack of epineurial tissue where the radial nerve passes the spiral groove of the humerus, due to decreased support and protection. Additionally, direct compression as the nerve passes the lateral tendon of the triceps during strenuous exercise may be another cause.

Conclusion: This is a rare case of bilateral radial neuropathy with suspected cause of proximal radial nerve compression from triceps hypertrophy/repetitive trauma following aggressive triceps exercise. While radial nerve injuries are relatively common, they are normally seen following trauma. We have seen three cases of police cadets with similar symptoms following circuit training programs. There is strong consideration to alter these training programs to avoid nerve injuries.

Level of Evidence: Level IV

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/exercise-induced-bilateral-radial-neuropathy-in-a-police-cadet-a-case-report/