Evolving Physical Therapy Treatment in Arm Pain of an Adolescent Throwing Athlete: A traditional Case Report

Background: It is becoming increasingly common for throwing athletes to experience upper extremity injuries, which can affect sport performance. There is a wide range of possible causes of upper extremity pain, and it is important to perform a thorough evaluation in order to accurately assess the full scope of the injury throughout the entire upper extremity kinetic chain. Treatment interventions may need to be altered throughout the plan of care in order to provide the most specific, patient-centered rehabilitation enabling successful return to sport if possible. The purpose of this case report is to describe the continuous assessment and evolving interventions provided to an adolescent throwing athlete with complaints of unilateral arm pain. Case Description: The patient in this report is an adolescent baseball pitcher with complaints of increased dominant arm pain over the course of the season. After a throwing assessment and additional information was discovered, interventions were shifted to provide a more specific, patient-centered rehabilitation program. Outcome Measures: The patient was examined and treated for 14 visits over the course of 6 weeks. Primary outcomes measured in this case were verbal pain ratings, functional limitations, and successful return to sport. More objective measurements could have been performed, such as hand-held dynamometry, QuickDash, and the SPADI, however, these were not performed secondary to a ceiling effect of the patient’s functional abilities and the symptoms only presenting following pitching. Discussion: Upper extremity injuries are common amongst adolescent throwing athletes. It is important to evaluate the entire kinetic chain as well as continuously assess the patient’s response to treatment and the need to shift interventions in order to provide a patient-centered rehabilitation program for a successful return to sport.