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Bilateral Triceps Atrophy in a Personal Trainer

Abstract

M. Nameer Sidiquee, Geisinger Orthopaedics and Sports Medicine, Wilkes-Barre, PA.

E-mail: MNSidiquee@geisinger.edu (Sponsor: David S. Ross)

HISTORY: A 41-year-old personal trainer with no significant PMH presents for evaluation of bilateral triceps muscle weakness and atrophy. He denies any specific injury but does report an instance when he had pain and swelling above his left elbow 5 years prior which developed subsequent to a weight lifting session. It was drained by his PMD and yielded dark red fluid. He reports progressive weakness and shrinking of his left posterior upper arm over the next 5 years. He also began having weakness and shrinking of his right posterior upper arm approximately 2 years ago. He has since regularly done triceps-specific exercises but reports a gradual weakening and significant atrophy of his bilateral triceps. He denies any neck or shoulder pain. He denies any paresthesias. He admits to anabolic steroid use 5 years ago. PHYSICAL EXAMINATION:

Inspection: significant atrophy of triceps bilaterally

Shoulder ROM:

ABD - 150’ bilaterally

ER - 90’ bilaterally

IR - 70’ bilaterally

FF - 150’ bilaterally

Tenderness: none

Strength:

Shoulder Abduction: Right - 5/5 Left - 5/5

Shoulder External Rotation: Right - 5/5 Left - 5/5

Shoulder Internal Rotation: Right - 5/5 Left - 5/5

"Empty can": Right - 5/5 Left - 5/5

Biceps: Right - 5/5 Left - 5/5

Triceps: Right-3/5 Left- 3/5

Peripheral pulses: normal

Reflexes: normal (Triceps 2+ bilaterally)

Sensation: normal

DIFFERENTIAL DIAGNOSIS: 1. Triceps tear 2. Triceps Denervation TEST AND RESULTS: MRI of left arm done 2 years prior showed mild-moderate triceps atrophy, greatest distally, and moderate triceps edema, greatest involving the mid to distal triceps about its insertion. No additional tests or studies done subsequently due to lack of patient follow up.

FINAL/WORKING DIAGNOSIS: Triceps atrophy due to chronic tear vs. denervation.

TREATMENT AND OUTCOMES: EMG ordered of bilateral upper extremities, to be done in 1 week and then follow up appointment planned.

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