Health Medical Homework Help

All replies must be constructive and use literature where possible.

• Juliete Misas.

Patient Evaluation & Management Plan

• “Lateral epicondylitis is one of the most common overuse syndromes seen in primary care, with an annual incidence of 1 to 3 percent; the condition affects men and women equally. Patients with lateral epicondylitis are typically 40 years or older and have a history of repetitive activity during work or recreation” (Johnson et al., 2007). According to the description for the clinical presentation of Epicondylitis it can be conclude that the patient presenting to the clinic is suffering from possible lateral Epicondylitis seeing as the patient age fits the description. The patient is 41 years of age, he reports being a construction worker which involves repetitive wrist dorsiflexion. The patient occupation will require him to overuse his extensor tendons of his forearm ultimately overtime leading to microtears, collagen degeneration, and angio-fibroblastic proliferation. Thus, diagnosis is confirmed via a history of occupational exposure to repetitive movement, replicated the symptoms of the condition via resisted supination or wrist dorsiflexion, while having the patient’s arm fully extended. The patient’s reported location of pain, correlates to the presentation of the condition which pain typically presents distal to the lateral epicondyle over the extensor tendon mass. Thus, all that is needed to confirm diagnosis of lateral Epicondylitis is patient history, differential diagnosis, and physical examination.

Seeing as the patient’s daughter appears hesitant to respond to any questions related to her father’s employment may led the practitioner to concluded that the patient is an undocumented worker. The most likely explanation for the patient’s daughter concern is that her father is an undocumented worker and might get into some sort of trouble if he involved his work into the scenario, he may also not have any sort of benefit at work such as workers compensation or health insurance.

While assessing the patient the clinician should palpate over the tender area. Perform range of motion movement to the affected extremity particularly focusing on stretching and extending out the affected area against restricting force. The physician may attempt to shake or grip the patient’s hand to see if they are able to reproduce the pain for the patient with these movement. The physician may also inquire with the patient if the pain is worst at night and if the patient finds it difficult to fully extend their arm in the morning.

According to the journal of occupational and environmental medicine clinical practice guidelines were developed for the treatment of lateral Epicondylitis the guidelines recommendation include “ restricting aggravating activity, followed by use of topical and oral NSAIDs, opioids should be avoided, self-application of heat or ice may be recommended, elbow straps use is recommended, wrist braces may be considered for adjunctive care of either more severe cases or those with suboptimal results with elbow straps and bands, both physical and occupational therapy is recommended and finally, surgery is recommended for cases inadequately responsive to multiple evidence-based treatments” (Hegmann et al.,2013) The journal of occupational and environment medicine bases their recommendations are based on research evidence and on expert consensus.

To help the patient and his daughter feel comfortable staying for treatment the practitioner can advise the patient that most of the treatment will be free of charge because best practice is rest. Education can be provided to both the patient and his daughter that he will need to rest the extremity to achieve resolution of symptoms. Most importantly advise the patient that if left untreated, lateral epicondylitis may persists for an average of 6 to 24 months. Apart from rest the patient can treat pain with over-the-counter NSAID’s that can be given to the patient at a reduced price with different coupon offers and the practitioner can contact the patient to community resources to help him cover the cost of treatment.

References

Hegmann, K. T., Hoffman, H. E., Belcourt, R. M., Byrne, K., Glass, L., Melhorn, J. M., … & Ording, J. A. (2013). ACOEM practice guidelines: elbow disorders. Journal of occupational and environmental medicine, 55(11), 1365-1374.

Johson, G. R. E. G. W., Cadwallader, K. A. R. A., Scheffel, S. C. O. T. B., & Epperly, T. E. D. D. (2007). Treatment of Lateral Epicondylitis. American Family Physician, 15(76), 843–848.