From the Research
For a female experiencing burning painful pronation for one month with negative nitrites in urinalysis, I recommend evaluation for medial epicondylitis, also known as golfer's elbow, as the primary cause of her symptoms, rather than a urinary tract infection. This condition is characterized by flexor-pronator tendon degeneration, which occurs with repetitive forced wrist extension and forearm supination during activities involving wrist flexion and forearm pronation, as described in the study by 1. The patient's symptoms of burning pain during pronation are consistent with medial epicondylitis, and the negative nitrite test in the urinalysis suggests that a urinary tract infection is less likely to be the cause of her symptoms. Initial management should include:
- Activity modification to avoid exacerbating the condition
- NSAIDs, such as ibuprofen 400-600mg every 6-8 hours as needed for pain, as recommended in the study by 1
- Consideration of corticosteroid injections for persistent symptoms
- Rehabilitation of the flexor-pronator mass to prevent further injury It is also important to note that the negative nitrite test does not rule out the possibility of a urinary tract infection, and empiric antibiotic treatment with nitrofurantoin 100mg twice daily for 5 days may be considered if a urinary tract infection is still suspected, as some infections may not produce nitrites, as mentioned in the study by 2. However, given the patient's symptoms and the negative nitrite test, medial epicondylitis is a more likely cause of her symptoms, and treatment should be focused on managing this condition. If symptoms persist after these interventions, referral to orthopedics or sports medicine is warranted for further evaluation and treatment.