Your patient is a 43-year-old female golfer who complains of arm ...

[saliriagwu]

Your patient is a 43-year-old female golfer who complains of arm pain. On physical examination, there is point tenderness on the elbow and pain when the patient is asked to flex the wrist against the clinician's resistance. These are typical signs of:
 
  A. Carpal tunnel syndrome
  B. Osteoarthritis of the wrist
  C. Epicondylitis
  D. Cervical osteoarthritis

Question 2

A 34-year-old baseball pitcher complains of pain in the left shoulder, particularly with raising the left arm when attempting to pitch. Which of the following is a test used to diagnose rotator cuff injury?
 
  A. Apley's test
  B. Trousseau test
  C. Hawkin's test
  D. A and C

[LVPMS]

Answer to Question 1

ANS: C
Epicondylitis involves inflammation of the tendon/tendon insertion of the forearms. This tendinitis results in either lateral elbow pain associated with overuse of the wrist extensors (tennis elbow) or in medial elbow pain associated with overuse of involving wrist flexion and rotation (golfer's elbow). Point tenderness is noted at the medial or lateral epicondyle. The onset and severity of pain is usually gradual and progressive but may have relatively acute onset following an activity involving significant repetitive use. The pain may be referred to the forearm and is increased by the offending motion (wrist flexion, extension, or rotation). Pain is usually greater when the motion is made against resistance.

Answer to Question 2

ANS: D
The rotator cuff consists of the supraspinatus, infraspinatus, subscapularis, and teres minor. Injury to the rotator cuff is typically due to chronic impingement with degenerative changes over time. The patient typically complains of anterior and lateral shoulder pain that increases with arm elevation and reaching overhead. The pain is usually progressive and may be associated with repetitive activities. Pain at night may cause sleep disturbance. ROM is typically preserved. Apley's (see Fig. 14.2) and Hawkins' (see Fig. 14.3) tests may reproduce the pain, depending on the component of the rotator cuff involved. There may be point or diffuse tenderness to the shoulder area. Crepitus and/or arm weakness suggest an acute tear.

[saliriagwu]

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