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?
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