ANSWER
Clinical Case Analysis: A Patient Who Does Not Speak English May Have Lateral Epicondylitis
Verifying the Lateral Epicondylitis Diagnosis
Repetitive wrist and forearm motions frequently result in lateral epicondylitis, also referred to as tennis elbow, which causes microtears in the tendons that attach to the elbow’s lateral epicondyle. To validate this diagnosis:
Patient History: It is crucial to get a thorough history of the pain’s beginning, progression, and aggravating circumstances. Enquire about past injuries, particular work tasks, and repeated motions.
Physical Assessment:
Tenderness: To feel for any soreness or swelling, feel the lateral epicondyle.
Pain in the Face of Resistance: Try the Mill’s test (passive wrist flexion with forearm pronated) or Cozen’s test (resisted wrist extension), which usually cause pain in lateral epicondylitis (Bateman et al., 2021).
Grip Strength: The diagnosis may also be supported by decreased grip strength on the afflicted side.
Imaging Research: Imaging tests like X-rays or an MRI can rule out other illnesses like fractures or ligament damage if the diagnosis is unclear or if symptoms do not go away with conservative treatment.
2. A Potential Reason for the Daughter’s Fear
There are several possible causes for the daughter’s distress, including:
Fear of Immigration Repercussions: If the patient is an undocumented worker, she might worry that disclosing the injury will result in problems with her job or the law. Many families without documentation steer clear of situations that can reveal their status.
Financial Concerns: If the patient is unable to work, the family may be concerned about the possible expense of treatment, particularly if they do not have insurance or fear losing their job.
Language Barrier: When a child is translating for her parent, she may feel overburdened or uncertain about how to properly explain the situation, particularly in delicate or complicated situations.
3. Further Evaluations for Lateral Epicondylitis
Along with palpation and ocular inspection, the following evaluations are to be carried out:
Range of Motion (ROM): To rule out other joint disorders, assess the ROM in the elbow, wrist, and shoulder.
Neurological Examination: To rule out nerve compression, such as radial tunnel syndrome, which can present with similar symptoms, check for sensory or motor impairments.
Functional Testing: To evaluate functional limitations, observe the patient’s capacity to carry out grasping or lifting tasks.
4. Lateral Epicondylitis Treatment
The goals of treating lateral epicondylitis are to reduce pain, encourage tendon repair, and stop more damage. Treatment based on evidence consists of:
Conservative Administration: Activity and Rest Change: Encourage the patient to cut back on repeated motions or heavy lifting, as these activities exacerbate the problem.
Pain management: To reduce pain and inflammation, take nonsteroidal anti-inflammatory medications (NSAIDs), such as ibuprofen (Bateman et al., 2021).
Physical therapy: Suggest forearm muscle strengthening and stretching activities.
Bracing: To lessen the tension on the tendons, use a brace or strap for the forearm.
Injection Therapy: Corticosteroid or platelet-rich plasma injections may be explored if symptoms continue after 6–8 weeks of conservative treatment.
Surgical Intervention: Although it is rarely required, severe, refractory cases may warrant surgery.
5. Resolving Issues with Patients and Families
It’s crucial to establish trust and allay the patient’s and his daughter’s anxieties when they say they want to go. Think about the following strategy:
Maintain Confidentiality: Assure them that their health and well-being are your top priorities and that the visit will remain private. Emphasise that their immigration status will not affect the care they receive and clarify that reporting the injury is not required.
Address Financial Concerns: whether the patient indicates that they are concerned about the cost, talk about free or inexpensive clinic options and find out whether your institution offers any financial aid programmes.
Employ Expert Translation Services: To ease the daughter’s stress and guarantee clear communication, offer to enlist the help of a qualified translation.
Cultural sensitivity and empathy: To build trust and help people feel appreciated and respected, acknowledge their worries and use a patient-centered, nonjudgmental approach.
In conclusion
The significance of comprehensive evaluation, patient education, and culturally competent care is shown by this example. Accurate diagnosis, cautious therapy, and open communication are essential to managing lateral epicondylitis. To guarantee patient compliance and a successful conclusion, it is imperative to address financial anxieties, legal issues, and linguistic limitations. This event emphasises how crucial flexibility and compassion are to advanced practice nursing, particularly when caring for vulnerable populations.
Citations
Hill, J. C., Adamson, G., and Bateman, M. (2021). A comprehensive evaluation of the treatment of lateral elbow tendinopathy. 55(4), 195-202, British Journal of Sports Medicine. 10.1136/bjsports-2020-102230 https://doi.org
Fineout-Overholt, E., and B. M. Melnyk (2018). Evidence-based nursing and healthcare practice: A best practice guide (4th ed.). Kluwer Wolters.
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.
1. 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?
2. 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?
3. Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
4. How is lateral epicondylitis treated?
5. 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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