A 17-year-old male presents to the clinic with a chief complaint of pain in his right elbow. He says the pain is sharp, especially with pronation and supination.  He noticed the pain several weeks ago after his tennis team went to a regional competition. 

QUESTION

Scenario 6: Lateral Epicondylitis

A 17-year-old male presents to the clinic with a chief complaint of pain in his right elbow. He says the pain is sharp, especially with pronation and supination.  He noticed the pain several weeks ago after his tennis team went to a regional competition. When he rests, the pain seems to go away. The pain is alleviated when he takes Naprosyn. No history of trauma or infection in the elbow. Past medical and social history non contributary. He is a junior at the local high school and just started taking tennis lessons 2 months ago and his coach is working with him on his backhand serve. Focused physical exam revealed point tenderness over the lateral epicondyle which increases with pronation and supination. The APRN diagnoses him with lateral epicondylitis and orders a wrist splint to prevent wrist flexion.

Question:

Why did the APRN feel a wrist splint would be helpful? What patient characteristics lead to this diagnosis.  

ANSWER

Lateral Epicondylitis: Diagnosis and Treatment Considerations

Introduction

Lateral epicondylitis, commonly known as tennis elbow, is a condition characterized by pain and inflammation in the tendons of the forearm muscles that attach to the lateral epicondyle of the humerus. It is often caused by repetitive wrist and forearm movements, particularly in activities such as tennis, hence the name. In this scenario, a 17-year-old male presented with complaints of right elbow pain, which worsens with pronation and supination. The advanced practice registered nurse (APRN) diagnosed the patient with lateral epicondylitis and recommended the use of a wrist splint. This essay aims to explain the rationale behind the APRN’s decision and the patient characteristics that led to the diagnosis.

Rationale for Wrist Splint Usage

The APRN recommended the use of a wrist splint to prevent wrist flexion in the patient. This treatment approach is based on the principle of reducing the load and stress on the affected tendons, allowing them to heal and recover (Ma & Wang, 2020). Wrist flexion is a movement that can exacerbate the symptoms of lateral epicondylitis by further straining the tendons responsible for extending the wrist.

A wrist splint acts as a supportive device that immobilizes the wrist and restricts its range of motion, thus minimizing the strain on the affected tendons. By preventing excessive wrist flexion, the splint helps alleviate the pain associated with lateral epicondylitis. It also provides stability to the wrist joint, allowing for optimal healing and preventing further injury during activities that involve gripping, lifting, or repetitive wrist movements.

Patient Characteristics Leading to Diagnosis

Several patient characteristics contribute to the diagnosis of lateral epicondylitis in this scenario. Firstly, the patient is a 17-year-old male who recently started taking tennis lessons and experienced pain after a regional competition. The onset of symptoms after engaging in activities involving repetitive wrist and forearm movements, such as tennis, aligns with the etiology of lateral epicondylitis (De Smedt et al., 2007). The repetitive stress placed on the tendons during these activities can lead to microtears and inflammation, causing the characteristic pain.

The patient’s pain is sharp, particularly with pronation and supination. This pain pattern is commonly seen in lateral epicondylitis, as pronation and supination involve the movement of the forearm muscles that attach to the lateral epicondyle. The presence of point tenderness over the lateral epicondyle, along with pain exacerbated by wrist movements, further supports the diagnosis.

Additionally, the patient reports pain relief with Naprosyn, a nonsteroidal anti-inflammatory drug (NSAID). This response to NSAID therapy is consistent with the inflammatory nature of lateral epicondylitis, reinforcing the diagnosis (Pattanittum et al., 2013). It is important to note that the absence of a history of trauma or infection in the elbow supports the diagnosis of lateral epicondylitis as a result of repetitive strain rather than an acute injury or infection.

Conclusion

In summary, lateral epicondylitis is a common condition characterized by pain and inflammation in the tendons of the forearm muscles. The APRN diagnosed the 17-year-old male patient with lateral epicondylitis based on his clinical presentation, which included pain exacerbated by pronation and supination, point tenderness over the lateral epicondyle, and a history of recent repetitive wrist and forearm movements during tennis activities. The use of a wrist splint was recommended to prevent wrist flexion, reduce strain on the affected tendons, and facilitate healing. By considering the patient’s characteristics and providing appropriate treatment, healthcare providers can effectively manage and alleviate the symptoms of lateral epicondylitis.

References

De Smedt, T., De Jong, A., Van Leemput, W., Lieven, D., & Van Glabbeek, F. (2007). Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. British Journal of Sports Medicine, 41(11), 816–819. https://doi.org/10.1136/bjsm.2007.036723 

Ma, K., & Wang, H. (2020). Management of Lateral Epicondylitis: A Narrative Literature Review. Pain Research & Management, 2020, 1–9. https://doi.org/10.1155/2020/6965381 

Pattanittum, P., Turner, T., Green, S., & Buchbinder, R. (2013). Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. The Cochrane Library. https://doi.org/10.1002/14651858.cd003686.pub2