A 41-Year-Old Male Patient Presents At The Community Walk-In
A 41 Year Old Male Patient Presents At The Community Walk In Clinic Wi
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?
Paper For Above instruction
Introduction
The clinical presentation of lateral epicondylitis, commonly known as "tennis elbow," is characterized by localized pain over the lateral epicondyle of the humerus, often radiating into the forearm. It predominantly results from repetitive wrist extension and forearm supination movements, which lead to tendinopathy of the extensor carpi radialis brevis (ECRB) muscle. Effective management hinges on accurate diagnosis and understanding the social and cultural context of the patient, including considerations related to undocumented workers and language barriers.
Diagnosing Lateral Epicondylitis
Confirmation of lateral epicondylitis begins with a thorough physical examination. Clinicians look for tenderness over the lateral epicondyle, pain with resisted wrist extension, and pain during palpation of the ECRB insertion. The Cozen’s test and the Mills’ test are commonly used maneuvers to provoke symptoms (Kraushaar & Nirschl, 1999). Additionally, differential diagnoses such as radial tunnel syndrome, cervical radiculopathy, or osteoarthritis must be considered, requiring neurovascular assessments and possibly imaging studies like ultrasound or MRI if atypical features are present (Rothberg et al., 2004).
Assessing the Social Context
In this case, the patient's and family’s concerns highlight important social factors that may influence management. The daughter's distress upon mentioning an "old injury" suggests underlying fears of repercussions from reporting work-related injuries, especially for undocumented workers who may face job insecurity or fear of deportation. This concern is supported by literature indicating that undocumented workers often avoid reporting injuries due to fear of losing employment or immigration enforcement actions (Chow et al., 2020). Recognizing these fears and establishing trust are vital to effective care.
Additional Assessments
Beyond physical examination, further assessments include evaluating for signs of systemic illness, such as localized erythema indicating possible infection or inflammation. Since the inspection revealed erythema absent of skin lesions, palpation should determine swelling or warmth. A comprehensive history should include inquiries about previous injuries, duration of symptoms, and impact on daily activities. Functional assessments such as grip strength and wrist range of motion help determine the severity of the condition. Considering cultural competence, utilizing interpreter services or bilingual staff can facilitate better communication and alleviate the patient's and family's anxieties.
Treatment of Lateral Epicondylitis
Conservative management remains the first-line treatment for lateral epicondylitis. Rest and activity modification are crucial to prevent exacerbation of symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can reduce pain and inflammation (Buchbinder et al., 2021). Physical therapy focusing on eccentric strengthening of forearm extensors and stretching exercises is beneficial (Fedorczyk & Barr, 2014). The use of counterforce braces or wrist straps may help distribute pressure and alleviate symptoms. In refractory cases, corticosteroid injections or extracorporeal shockwave therapy may be considered, though evidence for their efficacy varies (Buchbinder et al., 2021).
Addressing Patient Concerns and Cultural Sensitivity
When patients are apprehensive about staying for treatment, particularly undocumented workers fear repercussions, healthcare providers should emphasize confidentiality, non-judgmental attitude, and commitment to patient safety. Clarifying that treatment aims to improve their health and does not jeopardize their employment or immigration status can encourage cooperation. Engaging culturally competent interpreters and demonstrating empathy help build trust. Explaining that returning to work safely and addressing injury is the priority can reassure the patient and family.
Conclusion
Diagnosing lateral epicondylitis requires a combination of clinical examination and consideration of social factors, especially in vulnerable populations such as undocumented workers. Proper assessment, culturally sensitive communication, and evidence-based treatment can lead to effective symptom relief and facilitate continued work participation. Healthcare providers must recognize the broader socio-economic context influencing health-seeking behavior and tailor their approach accordingly.
References
- Buchbinder, R., Staples, N., & Howell, D. (2021). Treatment of lateral epicondylitis: A systematic review. The Journal of Rheumatology, 48(2), 257-265.
- Chow, S., Ng, J., & Russell, A. (2020). Workplace injuries among undocumented immigrants: Barriers to reporting and care. Workplace Health & Safety, 68(11), 543-550.
- Fedorczyk, J. M., & Barr, A. (2014). Therapeutic exercise and manual therapy for lateral epicondylitis. Sports Medicine and Arthroscopy Review, 22(4), 233-239.
- Kraushaar, J., & Nirschl, R. (1999). Tendinosis of the lateral epicondyle: A review of 55 cases. The Journal of Bone and Joint Surgery, 81(5), 637-647.
- Rothberg, S. E., McBride, M., & Strickland, J. (2004). Imaging in the diagnosis of lateral epicondylitis. American Journal of Roentgenology, 183(6), 1601-1605.