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?
Confirming the Diagnosis of Lateral Epicondylitis
To confirm the diagnosis of lateral epicondylitis, a physical examination should include:
- Palpation: Tenderness over the lateral epicondyle, especially with resisted wrist extension.
- Range of Motion: Assess wrist flexion, extension, radial, and ulnar deviation.
- Resisted Tests: Perform resisted wrist extension and supination to elicit pain.
Addressing the Daughter’s Concern
The daughter’s distress may be due to several factors:
- Fear of Immigration Consequences: Undocumented immigrants often fear deportation and may be reluctant to seek medical care due to concerns about their immigration status.
- Language Barrier: The language barrier may be causing additional stress and anxiety for the daughter.
- Financial Concerns: The patient may be worried about the cost of treatment, especially if he is uninsured.
Confirming the Diagnosis of Lateral Epicondylitis
To confirm the diagnosis of lateral epicondylitis, a physical examination should include:
- Palpation: Tenderness over the lateral epicondyle, especially with resisted wrist extension.
- Range of Motion: Assess wrist flexion, extension, radial, and ulnar deviation.
- Resisted Tests: Perform resisted wrist extension and supination to elicit pain.
Addressing the Daughter’s Concern
The daughter’s distress may be due to several factors:
- Fear of Immigration Consequences: Undocumented immigrants often fear deportation and may be reluctant to seek medical care due to concerns about their immigration status.
- Language Barrier: The language barrier may be causing additional stress and anxiety for the daughter.
- Financial Concerns: The patient may be worried about the cost of treatment, especially if he is uninsured.
