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.

Presenting Condition

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

PMH

Mild OA knee bilaterally

Appendectomy age 17

ORIF left wrist fracture 5 years ago

Social History

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)

Drug History

Ibuprofen - 200mg every 4-6 hours

Objective Summary 

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


Special Tests

Cozens +ve

Mills tests +ve 

Palpation - Pain on lateral aspect of elbow, common extensor origin and generally down into wrist extensor muscles.