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A 43-year-old female patient presents with complaints of left elbow pain which she reported having for about a year. The patient described the onset of elbow pain as gradual and attributed it to her previous work as an electronics assembler, where she spent the day pulling out plugs. Over time the pain had worsened to the point where it hurt all of the time. Although the patient had tried a course of anti-inflammatories, they had been discontinued due to an adverse reaction. The patient has since been placed on light duty at work with a lifting restriction of 10 lb. The patient reported no previous history of elbow pain and her past medical and surgical history were unremarkable.

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What is the most common diagnosis characterized by lateral elbow pain?

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The most common diagnosis characterized by lateral elbow pain is lateral epicondylitis.

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What does a history of gradual onset of an injury typically indicate?

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A gradual onset of symptoms is typically indicative of an overuse injury.

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Which vocations or avocations are commonly associated with lateral epicondylitis?

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The following vocations or avocations are commonly associated with lateral epicondylitis: tennis, racquetball, golf, carpentry, gardening, and needlework.

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What factors contribute to lateral epicondylitis in tennis players?

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The following factors contribute to lateral epicondylitis in tennis players: increased racquet stiffness, improperly sized racquet grip, heavy tennis balls, small racquet size, and high string tension.

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What is your differential diagnosis?

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The differential for lateral epicondylitis includes, but is not limited to, cervical spine disease, radiohumeral joint inflammation, and radial tunnel syndrome.

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What is radial tunnel syndrome and how is it associated with tennis elbow?

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Radial tunnel syndrome (RTS) involves compression of the radial nerve by the fibrous edge of the origin of the extensor carpi radialis brevis. RTS symptoms often mimic those of lateral epicondylitis.

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Does this presentation and history warrant an upper quarter screening examination? Why or why not?

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Based on the classic history, and a fairly clear mechanism of injury, this patient would not warrant an upper quarter screening examination.

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The physical examination should include an inspection for muscle atrophy, palpation for areas of tenderness and crepitation, muscle testing of all major muscles about the elbow, measurement of active and passive range of motion, observation of symmetry of carrying angle, and specific testing for tennis elbow and instability. The cervical spine and shoulder should also be examined and ruled out. The only positive findings from this patient were as follows:

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