Course Case Study - Tendinopathy 1
History of Presenting Condition
Bob is a 45 year old male who has recently started a new job as a manager at the local council offices 10 weeks ago. He has been experiencing a small amount of discomfort on the lateral aspect of his right elbow for some weeks but has noticeably got worse over the past 3 weeks. He has been to his doctor 2 weeks ago who prescribed him a short course of NSAIDs, of which have not helped significantly. He is now starting to develop pain down his forearm and into his hand.
He is experiencing pain on the lateral aspect of his right elbow which is now affecting his activities of daily living.
Aggravating factors – playing his guitar, typing on the keyboard at work, painting, using a screwdriver and rock climbing.
Easing factors – rest for less than 30 minutes, Ibuprofen occasionally, cold pack.
24 hour pattern pain –
- Morning - increased pain with stiffness 1st thing lasts for about an hour 5/10 VAS
- Daytime – Pain eases with gentle movement in the morning but by mid-afternoon 8/10 VAS struggles to work in the afternoon
- Evening – Dull ache late evening with intermittent sharp pain related to activity
Mild OA knee bilaterally
Appendectomy age 17
ORIF left wrist fracture 5 years ago
He is right hand dominant, works full time as a manager and the majority of time onto the computer sending emails and answering phone calls.
In his spare time he goes indoor rock climbing, plays the guitar and has been doing lots of DIY around the home including sanding and painting woodwork and walls.
Lives with his wife and 2 children (8 and 13 years old)
Ibuprofen - 200mg every 4-6 hours
Bob sits with a slightly slumped poking chin posture, he has possibly a small amount of swelling around the lateral aspect of his right elbow.
|Active ROM||Passive ROM||Ressisted ROM|
|Cervical||Full no pain||Full no pain||Full no pain|
|Shoulder||Full no pain||Full no pain||Full no pain|
|Elbow Flex||Full no pain||Full no pain||Full no pian|
|Elbow Exten||Full no pain||Full no pain||Full no pain|
|Elbow pronation||3/4 discomfort||Full discomfort||4/5 oxford, discomfort|
|Elbow Supination||3/4 discomfort||Full discomfort||4/5 oxford discomfort|
|Wrist Flexion||1/2 pain||3/4 pain||4/5 discomfort|
|Wrist Extension||1/2 pain||3/4 pain +||4/5 pain++|
|Radial Deviation||Full no pain||Full no pain||Full no pain|
|Ulna Deviation||Full no pain||Full no pain||Full no pain|
Mills tests +ve
Palpation - Pain on lateral aspect of elbow, common extensor origin and generally down into wrist extensor muscles.