The utility of electrodiagnostic inching study and conservative treatment in supracondylar process syndrome: A case report

Supracondylar process is a rare bony anomaly that can cause neurovascular symptoms. Previous reports on supracondylar process syndrome mostly suspect the condition by physical examination and simple radiograph with little assistance of electrodiagnostic methods and report efficiency of surgical treatment. A 45-year-old woman working at an assembly line packing boxes presented with tingling pain at her middle and ring fingers that started 2 months ago. She had positive Tinel sign at the medial side of the distal arm. Electrodiagnostic inching study on median nerve was conducted and the conduction velocity at the segment between 3 cm to 5 cm proximal to the elbow crease was decreased to 27m/s. Following imaging studies revealed supracondylar process at 4.2 cm proximal to the medial epicondyle. She was successfully treated with conservative treatment. Oral medications including Non-steroidal anti-inflammatory drug and pregabalin were prescribed along with superficial and deep heat modalities. The extent of manual labor was modified. Additionally, self-massage and stretching/nerve-gliding exercises were delivered. The symptoms substantially improved and she could sleep without trouble, however, complete resolution was not achieved. After a year, she was nearly symptom-free after changing occupations with only occasional tingling after manual labor of unusual intensity. This case report enlightens the versatility of electrodiagnostic inching study in localizing median neuropathy at the distal arm and the effectiveness of conservative treatment in supracondylar process syndrome.