ANSWER
Discussion of a Case of Lateral Epicondylitis Verifying the Diagnosis
Tennis elbow, often referred to as lateral epicondylitis, is frequently brought on by repeated action that overuses and inflames the tendons that join to the humerus’s lateral epicondyle. The following actions are necessary to confirm this diagnosis:
Taking History: Enquire in-depth about the type of discomfort, when it started, what caused it, any past injuries, and aggravating factors like lifting or repetitive wrist movements. To guarantee accurate communication, the translator can assist with this.
Physical Assessment: Conduct a targeted physical assessment:
Palpate the lateral epicondyle to feel for any sore spots.
Test of Resisted Wrist Extension: Lateral epicondylitis is indicated by pain when the patient resists wrist extension while the elbow is fully extended.
Mill’s Test: Extend the elbow and passively flex the wrist. Reproduced pain during this manoeuvre is a good result.
Grip Strength Test: Determine whether holding makes the afflicted arm weak or painful.
Imaging Research: Imaging such as X-rays can rule out other causes including arthritis or fractures, although they are typically not necessary. When tendon damage is severe or persistent, an MRI or ultrasound may be utilised to assess it.
Clarifying the Daughter’s Fear
There could be a number of reasons for the daughter’s obvious anguish when questioned about her father’s work and injury history:
Undocumented Status: If the patient’s family members are undocumented workers, they can be concerned about possible legal action if the injury is disclosed as a result of their job. They may be concerned about their job security as well.
Employer retribution: If the injury were to be reported as occupational, the daughter’s anxiety might suggest that she is aware of the possibility of employer retribution. Undocumented workers, who frequently experience exploitation and lack legal protections under labour laws, frequently have similar concerns.
Cultural Dynamics: The daughter might also be reluctant to translate delicate enquiries regarding her job and injury out of concern that it might exacerbate her father’s concerns or jeopardise family harmony.
Extra Evaluations
The following evaluations are essential in addition to visual inspection and palpation:
Assess the elbow, wrist, and finger range of motion as part of the functional assessment.
Examine the patient’s capacity to carry out daily duties including wrist movement and forearm strength.
Neurological Assessment:
Distinguish between nerve entrapments, including radial tunnel syndrome, which might resemble lateral epicondylitis symptoms.
Check for tingling or numbness in the hand and forearm.
Vascular Evaluation:
Palpate the radial and ulnar pulses to ensure adequate blood flow and rule out any vascular impairment.
Indicators of Infection:
Ask about any systemic symptoms, such as fever, which could point to an underlying infection, albeit this is unlikely given the lack of skin lesions.
Lateral Epicondylitis Treatment
A mix of conservative techniques and treatments are used to treat lateral epicondylitis:
Changes to Rest and Activity: Tell the patient to cut back on repeated wrist and forearm movements. Make ergonomic changes at work.
Ice and Heat Therapy: To lessen pain and inflammation, apply ice packs to the afflicted area.
Drugs:
Ibuprofen is one example of a nonsteroidal anti-inflammatory medicine (NSAID) that can help control pain and inflammation.
Physical therapy: Incorporate forearm muscle strengthening and stretching activities. When it comes to tendon recovery, eccentric workouts are especially beneficial.
Strap or Brace:
Recommending a counterforce brace can relieve symptoms and relieve tendon strain.
Injections: For chronic cases, platelet-rich plasma (PRP) therapy or corticosteroid injections may be taken into consideration.
Although it is rarely necessary, surgical intervention may be recommended in severe or persistent instances that do not improve with conservative treatment.
Taking Care of Patient and Family Issues
The patient’s anxiety and the daughter’s justification for having to leave could be signs of financial worries, mistrust of medical professionals, or fear of legal problems. To comfort them:
Make Confidentiality Clear: Describe how patient data is shielded by confidentiality rules and how their immigration status won’t be shared.
Emphasis on Care: Stress how critical it is to treat the damage in order to avoid permanent incapacity. To establish confidence, use plain language.
Talk about accessibility and costs:
Address low-cost or sliding-scale payment options offered by community health programmes if money is a concern.
Sensitivity to Culture:
Avoid asking harsh or inquisitive enquiries concerning their work or documentation status and instead demonstrate compassion and respect for their circumstances.
Support for Education: Give them information about how to manage lateral epicondylitis in the language of their choice and stress the importance of getting help as soon as possible.
In conclusion
The patient can feel comfortable receiving therapy if a thorough evaluation is conducted, the right diagnostic tests are used, and the family’s worries are sympathetically addressed. For patients who might be reluctant to seek medical attention because of their undocumented status or other socioeconomic difficulties, it is essential to establish a culturally aware and nonjudgmental approach.
Citations
Murrell, G. A. C., and B. M. Andres (2008). What works, what doesn’t, and what is coming up for tendinopathy treatment. 1539–1554 in Clinical Orthopaedics and Related Research, 466(7). 10.1007/s11999-008-0260-1 https://doi.org
Hooper, W. R., and R. W. Coonrad (1973). The course, natural history, conservative measures, and surgical options for treating tennis elbow. Bone and Joint Surgery Journal, 55(6), 1177–1183. 10.2106/00004623-197355060-00010 https://doi.org
QUESTION
A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm. His 13-year-old daughter is serving as a translator because her father is unable to speak English and understands only a few words in English. The daughter explains that he has been taking Tylenol to manage pain, but the pain is getting worse and is keeping him from working. You ask the daughter to describe the type of work her father does, and you notice she is hesitant to respond, first checking with her father. He responds, and she translates that he works in construction. Based on the response and the apparent concern, you suspect that the patient may be an undocumented worker. Further conversation reveals that several members of the family are working with the same local construction company.
- You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?
- While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?
- Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
- How is lateral epicondylitis treated?
- When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?
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