Intermittent Elbow Pain Case Study

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Case Description
This was a 51 year-old female patient who began experiencing intermittent elbow pain approximately 12-18 months prior to her initial visit. She began experiencing pain in the forearms and shoulders six to nine months prior to first visit, and pain in the shoulders, elbows and forearms have progressively increased since that time. Occasional aching and stiffness in the hands began two to three months prior to first visit and she noted lumps on the back of both wrists. She also noted neck pain and stiffness with daily headaches for six or more months prior to first visit. The patient was not employed and was a part-time online university student. She began limiting some homemaking activities six months prior to first visit and she discontinued college courses three months later. At the time of initial visit, her chief complaints were evening/night pain in the shoulders, elbows and forearms, with pain disrupting sleep multiple times each night. Driving increased upper extremity symptoms and aerobic exercise temporarily relieved symptoms. She relieved pain temporarily with heating pads to the forearms. She also reported temporary relief of upper limb pain by elevating both upper extremities overhead while seated or standing. Non-steroidal …show more content…
Hawkins test, empty can test and scarf test are described in Table 3 and were each performed and were negative. Special tests at the wrist/hand were performed to test for CTS. The Durkan, Tinel and Phalen tests (Table 1) were each performed and all tests were positive. Palpation of the posterior wrists was remarkable for mild swelling and mild discomfort. Due to the positive results in the CTS tests, thumb opposition was manually tested using pinch of the thumb to the fifth digit and was rated as 4-/5 bilaterally. The patient denies the presence of the Flick sign, as descried earlier.
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