Imaging Quiz: Elbow Pain in a Cyclist

Marvin Moe Bell, MD

THE PHYSICIAN AND SPORTSMEDICINE - VOL 25 - NO. 5 - MAY 97

[FIGURE 1] A 40-year-old man presented with left elbow pain in his nondominant arm and inability to pronate the left forearm. He had purchased a mountain bike 6 months earlier and had been riding approximately 30 miles per week over mostly flat terrain. He complained of gradually increasing left elbow and forearm pain during the previous month, with pain and stiffness on pronation that was worse the morning after biking. He sought medical attention when his inability to pronate the forearm interfered with daily activities, such as combing hair and brushing teeth.

Physical examination revealed tenderness over the proximal radioulnar joint that was exacerbated by attempted pronation. Pronation of the elbow was not possible past 0°, although supination, flexion, and extension of the elbow were normal. X-ray films of the patient's left elbow are shown in figure 1.

What is your diagnosis, and what treatment would you recommend?

Dr Bell is an associate director of the Scottsdale Memorial Family Practice Residency in Scottsdale, Arizona. Address correspondence to Marvin Moe Bell, MD, 7301 E Second St, Suite 210, Scottsdale, AZ 85251.

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