Musculoskeletal Complaint Case Study

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 cannot speak English and understands only a few words in English. The daughter explains that he has been taking TylenolÂ® 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 family members are working with the same local construction company. Please post your responses to the following questions in the Unit 9 Discussion Board. Case Questions 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. What would be the differential diagnoses? The main diagnosis? How is this condition treated?

Sample Solution

Take a history:Â Ask the patient about their pain, including its location, severity, and duration. Ask about any activities that make the pain worse or better. Ask about any other medical conditions they have.
Perform a physical examination:Â Examine the patient's elbow and forearm for tenderness, swelling, and weakness. You may also test the patient's grip strength.
Order imaging tests:Â In some cases, imaging tests, such as an X-ray or MRI, may be ordered to rule out other conditions that can cause pain in the elbow and forearm.

Full Answer Section

If the patient's history and physical examination are consistent with lateral epicondylitis, you can make a diagnosis without imaging tests. However, imaging tests may be ordered if the diagnosis is not clear or if you want to rule out other conditions.

Here are some questions you can ask the patient to help confirm the diagnosis of lateral epicondylitis:

Where is the pain?
How long have you had the pain?
What makes the pain worse?
What makes the pain better?
Have you had any other injuries to your elbow or forearm?
Do you do any activities that involve repetitive use of your wrist or forearm?
Have you noticed any weakness in your grip?

The patient's daughter may be concerned because she is worried about her father's financial security. If the injury is work-related, her father may be entitled to workers' compensation benefits. Workers' compensation benefits can help to pay for medical expenses and lost wages.

The daughter may also be concerned about her father's ability to work. If the injury is severe, her father may not be able to work for a period of time. This could have a financial impact on the family.

It is important to reassure the daughter that you will do everything you can to help her father. You can also explain the benefits of workers' compensation and how to file a claim.

Here are some additional things you can do to help the patient and their daughter:

Refer the patient to a physical therapist who can help them develop an exercise program to strengthen the muscles in the elbow and forearm.
Provide the patient with information about how to prevent further injury.
Be supportive and understanding of the patient and their family.

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