ANSWER
Examining and Treating Lateral Epicondylitis in a Case Study
Verifying the Lateral Epicondylitis Diagnosis
A comprehensive history and targeted physical examination are necessary to confirm the diagnosis of lateral epicondylitis, sometimes known as “tennis elbow.” The steps listed below can aid in making the diagnosis:
Tests that provoke:
Ask the patient to extend their wrist against resistance as part of the Cozen’s Test. Lateral epicondylitis is suggested by pain at the lateral epicondyle.
Mill’s Test: Pain can be replicated by passively flexing the wrist while extending the elbow.
Maudsley’s Test: The extensor carpi radialis brevis (ECRB) tendon can be confirmed to be involved if pain is felt when the middle finger is extended against resistance.
Feeling:
Check for the telltale sign of discomfort over the lateral epicondyle.
Testing for Range of Motion (ROM):
To make sure there are no other underlying disorders, such as joint stiffness or nerve entrapment, assess the range of motion in the elbow and wrist.
Picture:
Even though lateral epicondylitis is usually diagnosed clinically, if conservative treatment fails to alleviate symptoms, imaging tests (such as MRIs or X-rays) may be required to rule out other illnesses such fractures, arthritis, or tendon tears.
A Potential Reason for the Daughter’s Fear
There are a number of reasons why the daughter could be distressed and reluctant to share information:
Status of Undocumented Workers:
The father may be working in hazardous conditions or without the required paperwork, which could cause the family to worry about legal or job consequences.
Concerns about money:
If the injury is reported, one may lose their job or be denied future employment prospects. The daughter’s insistence that the injury occurred before he started working for the construction company may have been motivated by this worry.
Language or cultural barriers:
Mistrust and a reluctance to give information may result from the patient and his daughter’s unfamiliarity with healthcare rights and confidentiality in the United States.
Preserving the stability of the family:
If her father is the family’s main provider, the daughter might feel compelled to protect him from possible repercussions.
Other Evaluations to Complete
Along with the provocative tests and visual inspection, the following evaluations are to be carried out:
Neurological Assessment:
Check for symptoms of nerve compression, such as weakness in the radial nerve distribution or sensory deficiencies.
Testing for Strengths:
Assess grip strength, as it may be diminished in cases of lateral epicondylitis.
Evaluation of Function:
Find out if the patient has trouble with everyday chores or work-related activities that require repetitive wrist or arm movements.
Reducing repetitive strain, improving tendon repair, and relieving symptoms are the main goals of treatment for lateral epicondylitis.
Conservative Care:
Rest: Suggest refraining from activities that make symptoms worse.
Ice Therapy: To lessen inflammation, apply ice to the afflicted area two to three times a day for 15 to 20 minutes.
NSAIDs, or nonsteroidal anti-inflammatory drugs: Ibuprofen and other over-the-counter NSAIDs help reduce inflammation and discomfort.
Physical therapy: Symptoms might be alleviated by forearm muscle strengthening and stretching activities.
Orthopaedic Equipment: The ECRB tendon may experience less strain if a counterforce brace is used.
Options for Intervention:
Platelet-rich plasma (PRP) therapy or corticosteroid injections may be explored if symptoms do not improve with conservative approaches.
Surgical Intervention:
reserved for long-term conditions that don’t improve with other therapies after six to twelve months.
Assuring the Daughter and Patient
The following details should be highlighted in order to ensure the patient and his daughter are comfortable and receive the attention they require:
Maintaining confidentiality:
Remind patients that their access to care will not be impacted by their immigration or legal status and that healthcare providers are dedicated to protecting their privacy.
Obtaining Reasonably Priced Healthcare:
If cost is a concern, provide details about financial aid programmes or community clinics.
Support for Education:
Inform them of the illness and stress that prompt care might avoid problems and enable the patient to resume work sooner.
Compassion and Nonjudgmental Treatment:
Establish trust by compassionately addressing their anxieties and providing a secure environment for candid dialogue.
In conclusion
The difficulties of identifying and treating lateral epicondylitis in a patient who may have sociocultural barriers are demonstrated by this instance. Achieving the best results requires resolving issues with undocumented status, confirming the diagnosis with clinical testing, and offering tailored therapy.
Citations
Marcelis, S., Boulet, C., & De Maeseneer, M. (2020). The pathophysiology, diagnosis, and management of lateral epicondylitis. 37(4), 184–190, Journal of Musculoskeletal Medicine.
Vicenzino, B., Bisset, L., and Coombes, B. K. (2015). There is no one-size-fits-all approach to treating lateral elbow tendinopathy. https://doi.org/10.2519/jospt.2015.5841 Journal of Orthopaedic & Sports Physical Therapy, 45(11), 938–949.
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?
Submission Instructions:
- Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
- Reply back