Understanding Lateral Epicondylitis in an Undocumented Worker

 

Understanding Lateral Epicondylitis in an Undocumented Worker

Confirming the Diagnosis

To confirm the diagnosis of lateral epicondylitis (commonly known as “tennis elbow”), you can perform several specific assessments during the physical examination:

1. Palpation: Gently palpate the lateral epicondyle of the humerus to identify tenderness. This is typically a focal point of pain in patients with lateral epicondylitis.

2. Range of Motion (ROM) Assessment: Evaluate both active and passive movements of the elbow and wrist. Pain during wrist extension, particularly against resistance, can support the diagnosis.

3. Cozen’s Test: Ask the patient to extend their wrist while you apply resistance. Pain at the lateral epicondyle during this maneuver is indicative of lateral epicondylitis.

4. Mill’s Test: Extend the patient’s elbow and flex the wrist while applying pressure to the forearm. Pain during this test further supports a diagnosis of lateral epicondylitis.

5. Functional Assessment: Inquire about any activities that exacerbate the pain, particularly repetitive wrist and forearm movements typical in construction work.

Understanding the Daughter’s Concern

The daughter’s distress upon discussing her father’s injury may stem from a few potential concerns:

– Fear of Implications: She likely fears that reporting a work-related injury could lead to repercussions for her father, especially considering his undocumented status. This fear might involve job loss, legal issues, or deportation.

– Concerns about Healthcare Access: They may also be worried about the implications of seeking medical care, including costs or potential interactions with authorities.

– Cultural Sensitivity: There may be cultural factors at play, where discussing injuries and workplace safety could be stigmatized or not openly addressed within their community.

Additional Assessments

In addition to visual inspection revealing erythema without skin lesions, consider performing:

1. Neurological Assessment: Check for any signs of nerve involvement, such as tingling or numbness in the forearm or hand, which could indicate radial nerve entrapment.

2. Strength Testing: Assess grip strength and resistance to wrist extension to evaluate functional impairment.

3. Circulation Assessment: Ensure there are no vascular issues by checking capillary refill and pulse in the radial and ulnar arteries.

Treatment of Lateral Epicondylitis

Management of lateral epicondylitis typically involves a combination of conservative measures:

1. Rest and Activity Modification: Advise the patient to modify activities that exacerbate symptoms and incorporate rest to allow healing.

2. Ice Therapy: Recommend applying ice to the affected area for 15-20 minutes multiple times a day to reduce inflammation.

3. Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): If appropriate and safe, suggest using NSAIDs (like ibuprofen) for pain relief and inflammation reduction, considering any potential contraindications.

4. Physical Therapy: Referral to a physical therapist for specific exercises aimed at strengthening forearm muscles and improving flexibility can be beneficial.

5. Bracing: Consider recommending a forearm brace or splint to reduce strain on the elbow during activities.

6. Corticosteroid Injections: In refractory cases, corticosteroid injections may be considered to reduce inflammation.

Addressing Patient Concerns

To help the patient and his daughter feel comfortable staying for treatment, you could say:

“I understand that you may have concerns about your situation, and I want you to know that your health and safety are our top priorities here. We are here to help you manage your pain and find a solution without any fear of judgment or repercussions. You are not alone in this process, and we can work together to find the best way forward for your health. If you stay, we can discuss options that can help improve your condition without any pressure. Your well-being matters, and we want to ensure you receive the care you need.”

This reassurance addresses their fears directly and emphasizes a supportive environment focused on health rather than legal status.