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Posted: September 28th, 2023

A 41-year-old male patient presents at the community walk-in clinic

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?
Submission Instructions:

Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.

To confirm the suspected diagnosis of lateral epicondylitis, I would perform a physical examination focused on the elbow. Specific tests like resisted wrist extension and palpation over the lateral epicondyle can help identify tenderness characteristic of this overuse injury (Struijs et al., 2004).
The daughter’s concern about her father reporting the injury to his employer suggests this may be an undocumented worker without access to standard workplace protections or healthcare (Acevedo-Garcia et al., 2014). Earning a living is understandably a high priority, so openly discussing legal status could compromise that and deter seeking needed medical care (Capps et al., 2015).
Further physical assessment should include evaluating range of motion, grip strength, and assessing for neurological deficits like numbness, tingling or weakness that could indicate a more serious condition (Nirschl & Sobel, 1990).
Initial treatment for lateral epicondylitis focuses on reducing inflammation and strengthening the extensor carpi radialis brevis muscle. Recommendations may include rest, ice, oral anti-inflammatories, bracing, stretching and strengthening exercises (Struijs et al., 2004).
To help the patient and daughter feel comfortable remaining for treatment, I would reassure them that my primary concern is proper medical care, not legal status, and emphasize the importance of addressing this work-related injury before it worsens or healing is impeded (Capps et al., 2015). Earning trust and providing culturally-sensitive care are especially important for undocumented immigrant populations (Acevedo-Garcia et al., 2014).
References:

Acevedo-Garcia, D., Sanchez-Vaznaugh, E. V., Viruell-Fuentes, E. A., & Almeida, J. (2014). Integrating social epidemiology into immigrant health research: A cross-national framework. Social Science & Medicine, 110, 20–28. https://doi.org/10.1016/j.socscimed.2014.03.033
Capps, R., Fix, M., Van Hook, J., & Bachmeier, J. D. (2015). A demographic, socioeconomic, and health coverage profile of unauthorized immigrants in the United States. Migration Policy Institute. https://www.migrationpolicy.org/research/profile-unauthorized-immigrants-united-states
Nirschl, R. P., & Sobel, J. (1990). Tennis elbow. The surgical treatment of lateral epicondylitis. The Journal of Bone and Joint Surgery. American Volume, 72(5), 832–841. https://doi.org/10.2106/00004623-199072050-00011
Struijs, P. A., Kerkhoffs, G. M., Assendelft, W. J., & van Dijk, C. N. (2004). Conservative treatment of lateral epicondylitis: brace versus physical therapy or a combination of both-a randomized clinical trial. The American Journal of Sports Medicine, 32(2), 462–469. https://doi.org/10.1177/0363546503261724

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