Looking further when symptoms are disproportionate to physical findings

A 36 year-old male presents with left ulnar-side wrist pain during an ice hockey game that prevented him from playing hockey or golf. There was no acute mechanism of injury. The usual clinical examination revealed only minimal tenderness and minimal pain with resisted wrist extension. Careful attention to precipitating factors led to testing resisted wrist extension with the forearm fully supinated, which reliably reproduced the intensity of the patient's symptoms, and a diagnosis of extensor carpi ulnaris tendinopathy. A literature review suggested three additional special tests (two were positive) and management. However, a standard of care has yet been established as neither the tests nor the management has been properly validated through research, thus leaving the management of this condition as an art. Corresponding Author: Ian Shrier MD, PhD, Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote Sainte-Catherine Road, Montreal, QC H3T 1E2, Canada. Email: ian.shrier@mcgill.ca. Tel: 1-514-340-7563; Fax: 1-514-340-7564 The authors have no conflict of interests to report. This report was unfunded. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute endorsement by ACSM. Accepted for Publication: 26 July 2018 © 2018 American College of Sports Medicine

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