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Upper limb case: AG 32yo M with Elbow pain (Person (Professional Socialism…
Upper limb case: AG 32yo M with Elbow pain
Person
Dialoguism
Works as a carpenter: avoid using jargon but explain things using layman terms so that he receives education on his injury and pain
Set clear boundaries for work and exercise: Avoid using terms that may increase pain sensitivity
Personality: patient does not ask many questions
Ask him questions
Professional Socialism
Has not contacted other health professionals
Education re: expectations with other healthcare professionals
Establish clear expectations re: injury timeline, conservative management, and alternatives
Appears musculoskeletal in nature, nil neurological component or reg flags identified
No need for referral to other health care professionals
Reduced work load - however has not taken time off of work for this issue
Monitor condition, and if necessary r.v. for reducing work duties for load management
Narrative Based Reasoning
Work: Carpenter, finds activities from work aggravating
Goals: Return to work pain free
Hobbies: Oztag, gym/weight lifting
Goals: Return to oztag, and weightlifting
Home: Lives with partner and children
Has had this issue for some time (12/12?) however has not consulted anyone professionally about the issue. His cousin is a health practitioner who identified that he may have lateral epicondylgia or "tennis elbow". This then lead to his decsion to seek professional treatment.
Science
Hypothetico-deductive reasoning
Aggravated by work activities
Holding hammer, nail gun, drill
Repetitive wrist extension with radial deviation
Grip strength?
Elbow extended Forearm Pronated L=15kg (6/10) R=52.3kg
Elbow extended Forearm Supinated L=14.1kg (7/10) R=53kg
Elbow supported at 90 Forearm Neutral L=18.1kg (6/10) R=58.1kg
Least painful position
Elbow extended Forearm Neural L 14.5 (6/10) R = 54.9
Elbow supported at 90 Forearm Pronated L=14.1kg (6/10) R=60.8kg
Elbow supported at 90 Forear Supinated L=15kg (7/10) R=60kg
Grip strength markedly reduced on Left side in all 3 positions with *pain in supinated position
Weak shoulder
ULTT L: slight restriction R= nil
nil P/N
Pattern recognition; Practice based evidence
Previous left shoulder injury
Altered biomechanics, predisposition to injury
Weak shoulder musculature,
Coming from Thoracic spine?
ROM L=64 R=66
Compromised shoulder range
Flexion L=R
ABD L=R
IR L>R
ER L>R
Wrist
Reduced Supination
ROM
Reduced supination of the wrist
Location of injury
Hand
Wrist ROM: reduced supination
Elbow CEO: associated with lateral epicondylgia
Reduced Grip strength in all positions, and painful
Positive 3rd digit extension reproductive of pain
Evidence Based Practice
Isometrics wrist extension: 40 second holds x 5
Reduced pain, improved symptoms, and increased strength
Home exercise prescription: Isometrics 40 sec x 5, as needed for pain
Progression after r.v. 2x6 tendon isos, improve shoulder strength
Taping for proprioception and decompression; reduction in symptoms and pain
STR of CEO, Extensors and flexors