From the Guidelines
For numbness and pain radiating from the left bicep down to the hand in a basketball player, I recommend starting with a physical examination, including neurological testing, followed by an MRI of the left arm, specifically the elbow and forearm, without IV contrast, as it is the most accurate imaging modality for assessing ligamentous and tendinous injuries, such as distal biceps tendon pathology, as shown in the study by Schenkels et al 1.
The patient's symptoms suggest possible nerve compression or tendinous injury, and an MRI without IV contrast can help identify the underlying cause. The study by Nicolay et al 1 found that MRI has an improved sensitivity for the detection of partial tears of the biceps and triceps tendons. Additionally, the FABS (flexion-abduction-supination) MRI view can be useful in evaluating distal biceps tendon pathology, as it allows for the visualization of the entirety of the tendon on a single image, as described by Giuffre et al 1.
While ultrasound (US) can be an alternative to MRI in evaluating the distal biceps tendon, as shown in the study by Deschrijver et al 1, MRI remains the most accurate imaging modality for assessing ligamentous and tendinous injuries. The study by Lynch et al 1 found that US has a lower sensitivity and specificity compared to MRI in detecting complete distal biceps tendon rupture.
In terms of treatment, the patient should temporarily modify basketball activities, use NSAIDs like ibuprofen (400-600mg three times daily with food) for pain, and apply ice to reduce inflammation. Physical therapy focusing on proper posture, neck and shoulder strengthening, and nerve gliding exercises may help relieve symptoms regardless of the underlying cause, as suggested by the study by Chen et al 1.
Some key points to consider in the diagnosis and treatment of this patient include:
- The importance of a thorough physical examination, including neurological testing, to assess sensation, strength, and reflexes
- The use of MRI without IV contrast as the most accurate imaging modality for assessing ligamentous and tendinous injuries
- The potential benefits of the FABS MRI view in evaluating distal biceps tendon pathology
- The limitations of US in detecting complete distal biceps tendon rupture
- The importance of modifying activities, using NSAIDs, and applying ice to reduce inflammation and relieve symptoms.
From the Research
Possible Causes of Numbness and Pain
- Numbness and pain radiating from the left bicep down to the hand can be caused by central or peripheral nervous system abnormalities, as stated in 2
- Peripherally induced paresthesias can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies, and miscellaneous conditions, as mentioned in 2
Diagnostic Tests
- Confirming the diagnosis and establishing an etiology may require appropriate laboratory and radiologic studies, or other studies, as stated in 2
- Magnetic Resonance Imaging (MRI) can be useful in evaluating orofacial pain and paresthesia, and is more effective than Computed Tomography (CT) scans in detecting the causative disease, as shown in 3
- Functional MRI (fMRI) can be used to investigate the pharmacological effects of a drug on pain processing, as demonstrated in 4
Relation to Basketball
- There is no direct evidence in the provided studies that links basketball to numbness and pain radiating from the left bicep down to the hand
- However, trauma or injury from playing basketball could potentially contribute to the development of paresthesias, as mentioned in 2
Further Evaluation
- A thorough medical evaluation, including a physical examination and medical history, is necessary to determine the underlying cause of the numbness and pain, as implied in 2
- Additional tests, such as electromyography (EMG) or nerve conduction studies (NCS), may be necessary to diagnose and treat the condition, although not explicitly mentioned in the provided studies 5, 6