A Violinist And Her Elbow

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A Violinist And Her Elbow - Page #1

Author: Stanley Szybinski, M.B.B.S. Co Author #1: Jonathan Santana, D.O. Co Author #2: Joseph Chorley, M.D. Senior Editor: Natalie Stork, MD Editor: Elizabeth Portin, DO Patient Presentation: A 17-year-old right hand dominant female presented to the sports medicine clinic with 4-months of chronic right elbow pain that had acutely worsened over the past 4-weeks without any known trauma. History: The patient was involved in the fine arts and played viola at least 10-15 hours per week. She stated that the elbow pain was worse with flexion and holding her instrument, and the pain sometimes radiated to her wrist. She felt like it was "achy" and as if there was a "bubble" stuck in the elbow. She denied, swelling, catching, or locking of the elbow. She did not recall any recent trauma and did not participate in high impact physical activities such as gymnastics or cheerleading. She denied fever, weight loss, or other joint involvement. Physical Exam: Vitals: Height- 163 cm Weight- 94 kg BMI- 35 kg/m2 Blood Pressure- 98/65 Heart rate- 70 Temperature- 37.2 C Right elbow exam: -Observation: No deformity, ecchymosis, or swelling -Range of motion: Flexion limited by 20 degrees secondary to pain, painless full extension, supination, and pronation -Palpation: Tenderness over the lateral epicondyle and olecranon, no tenderness over medial epicondyle or other bony prominences or musculature -Strength: 4/5 resisted elbow and wrist extension, and 5/5 wrist flexion, supination, pronation, elbow flexion and grip strength -Special tests: Varus and valgus stress testing negative, Tinel's sign negative at cubital and radial tunnel Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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