ANSWER
Verifying the Diagnosis of Lateral Epicondylitis via Case Analysis and
The following actions should be performed in order to confirm a diagnosis of lateral epicondylitis, also known as tennis elbow:
In-depth Background:
Get a detailed history of how the pain started, lasted, and changed.
Enquire about grasping, lifting, and repeated motions like those employed in construction that make the pain worse.
Physical Assessment:
Tenderness: To feel for localised tenderness, feel the lateral epicondyle.
Cozen’s Test: Ask the patient to palpate the lateral epicondyle while extending their wrist against resistance; if pain is reproduced, the patient has lateral epicondylitis.
By passively flexing the wrist while extending the elbow, Mill’s Test verifies the diagnosis by detecting pain above the lateral epicondyle.
Test of Grip Strength: Determine whether the afflicted arm is weaker than the unaffected side.
Eliminate Distinctive Diagnoses:
If the results do not support lateral epicondylitis, consider inflammatory diseases like arthritis or nerve entrapments like radial tunnel syndrome.
Clarifying the Daughter’s Fear
The daughter’s anguish is probably caused by:
Undocumented Status: Reporting a work-related injury to an undocumented patient could reveal the family’s legal status and put them at risk of deportation or losing their employment.
Financial Concerns: If the father is unable to work or if the costs of his medical care become too high, the family may worry that he will lose his job.
Cultural or Family Dynamics: The daughter may feel overburdened by the duty of protecting her father from alleged damage and translating delicate matters.
Extra Evaluations
Evaluation of Function:
Check your wrist and elbow range of motion.
Check for restrictions on everyday tasks like gripping or lifting.
Neurological Evaluation:
Check for indications of nerve compression or involvement of the radial nerve, as these conditions can resemble or coexist with lateral epicondylitis.
Evaluation of the Musculoskeletal System:
Check for further causes of pain or inflammation by palpating the nearby muscles and joints.
Evaluation of Inflammation and Infection:
To rule out cellulitis or another inflammatory disease, check for warmth, swelling, or fever even while erythema is present.
Non-pharmacological therapies for lateral epicondylitis include:
Rest: Adjust or stay away from activities that make symptoms worse.
Ice: To lessen inflammation, use ice packs to the lateral elbow three to four times a day for 15 to 20 minutes.
Bracing: To relieve tension on the extensor tendons, use a forearm strap or counterforce brace.
Physical therapy: Suggest strengthening and stretching activities that target the extensor tendons’ eccentric loading.
Pharmacological Interventions:
NSAIDs: To relieve pain and reduce inflammation, prescribe naproxen or ibuprofen.
Topical NSAIDs: Provide targeted pain relief for people who are wary about taking oral drugs.
Advanced therapies (if refractory or severe):
Injections of corticosteroids provide temporary comfort, but prolonged treatment may damage the tendon.
For persistent, resistant cases, platelet-rich plasma (PRP) therapy or surgery may be necessary.
Resolving the Patient’s Fear of Leaving
To ensure that the patient and his daughter are at ease during their stay for treatment:
Recognise Their Concerns:
“I understand you are concerned, and I want to assure you that my role here is to help with your pain and provide care.”
Stress the Need for Confidentiality:
“Your stay here is kept totally private. I don’t tell anybody outside of this clinic about your work or family.”
Explain the Significance of Care:
“Without therapy, the discomfort you’re feeling could worsen. Together, we can help you recover so you may resume your job in a safe manner.
Provide Extra Assistance:
To lessen the daughter’s burden, provide culturally sensitive care by providing expert translation services, if accessible.
In conclusion
Pharmacological treatments, non-pharmacological approaches, and lifestyle changes can all be used to effectively manage lateral epicondylitis. The patient will feel supported and comfortable to receive care if you establish trust with them and address their worries, especially those related to confidentiality and financial repercussions.
Citations
Vicenzino, B., and L. Bisset (2015). Novel ideas about the pathophysiology and treatment of lateral epicondylitis. BMJ, 351, h4725.
Orthopaedic Surgeons’ American Academy (2020). Tennis elbow is known as lateral epicondylitis. taken from the website https://orthoinfo.aaos.org
Ashman, E. S., and R. P. Nirschl (2021). Tennis elbow is a type of elbow tendinopathy. 20(4), 697–715, Clinics in Sports Medicine.
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?