Epicondylitis Case Studies

DOI: 4/01/2015. The patient is a 53-year-old-male old carpenter /foreman who sustained a work- related injury while lifting a high beam when the beam slipped before being placed into the ground pushing him between the beam and leads, crushing his right ankle and foot.

Based on the progress report dated 10/07/16, the patient presents for evaluation of carpal tunnel syndrome on the right shoulder.

Based on the medical report dated 12/22/16, the patient was last seen on 10/13/16, and was recommended to have continued therapy. He has not had therapy secondary to insurance issues over the last month or so. He presents with ongoing right elbow pain status post cubital tunnel release and medial epicondylitis debridement, worsening with motion and activity, lifting, reaching, bending, upper extremity dressing, household

Based on the orthopedic consultation report dated 03/04/16 by Dr. Strudwick, the patient reports that his symptoms have returned and he has pain at night with elevation, pushing, pulling, reaching and heavy lifting at shoulder level and above.

Repetitious micro trauma or overuse to muscles, bones, joints and ligaments are known injuries seen in athletics. Repetitious stress at the elbow joint is a frequent seen chronic injury occurring in the tennis athletes. Numerous researchers specified that the wrist extensors, extensor carpi radialis brevis and longus and extensor digitorum, showed marked activity during portions of the serve, forehand and backhand strokes (Morris et all., 1989; Giangarra et all., 1993). Therefore, with a marked increase in activation of the wrist extensors, lateral epicondylitis is a widespread type of overuse injury seen in the tennis athletes. Lateral epicondylalgia is often attributed to work related repetitive strain injuries but is also a common sports

IMAGING: X-ray reveals a tibial eminence displaced fracture. He is skeletally immature, as his age indicates.

Electrodiagnostic consultation report dated 10/02/15 revealed normal study of both upper limbs and cervical paraspinals. No evidence of cervical radiculopathy. No median or ulnar neuropathy.

X-ray of the right hand/wrist dated 09/27/2017 showed an acute fracture that involved the distal metaphysis right radius with 2mm separation. There was a dorsal angulation of the distal segment. There was a subtle avulsion fracture involving the styloid processes of the distal ulna.

DOI: 12/20/2010. Patient is a 63-year-old female compliance support specialist who sustained a work-related injury when she slipped and fell on wet tile floor. Per OMNI, she strained her left wrist, left shoulder and neck.

PHYSICAL EXAM: Examination shows comparing the right hand to the left, including the hand and wrist region, that there are skin scratches, very superficial, from activity. There is no tenderness. There is no soft tissue swelling. There is normal alignment. No deep tenderness to palpation over the fractures. No crepitus. No instability. Active range of motion is about 85% of the contralateral left side.

Begovic et al,. (2016) explains deep transverse frictions has often been used for conditions such as chronic lateral epicondylitis, iliotibial syndrome and patella tendinitis. Furthermore, DTF aids analgesia, hyperaemia and the breakdown of scar adhesions to ligaments, tendons and muscles. Coninck (2015) states that DTF should not be used on patients with the following conditions: local sepsis, rheumatoid tendinous lesions and skin disease.

Based on the medical report dated 01/03/17, the patient presents for pain/dysfunction of the right wrist. IW states repetitive heavy lifting and complains of numbness, tinging and weakness.

O: Inspection of right elbow - No edema, discoloration, or swelling noted; tenderness with palpation near the lateral elbow when the wrist is bent forward; right hand Grip strength: Right +4, Left +5

Muscle testing shows 4+/5 with elbow flexion. Active range of motion shows flexion of 127 degrees and abduction of 140 degrees. IW was assessed to have difficulty activating external rotator at the left shoulder in mid-range elevation arc. IW was advised to continue with current rehabilitation program.

DOI: 11/10/2006. The patient is a 54-year-old female customer service representative who sustained a sprained right ankle while going down stairs leaving work.