PT Question of the Week - Slow onset of elbow pain

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You are examining a 32-year-old female with complaints of chronic left elbow pain in her dominant arm, rated at 6/10, that has gradually worsened. The patient cannot recall any specific injury to the elbow but notices that the symptoms worsen after playing racquetball. Typically the elbow hurts more as the day progresses, and she wakes up at night only if she sleeps on his arm. The patient denies feeling numbness or tingling in the upper extremity, but the pain occasionally radiates down to her knuckles. The patient has had no previous issues with the left elbow, and her past medical history is unremarkable.

Your examination begins with a general inspection of the area, including skin integrity and temperature, and you note that her proximal posterior forearm is warmer to the touch than the non-involved side finger, elbow, shoulder, and cervical range of motions are within normal limits. Wrist flexion is 55°, wrist extension is 50°, supination is 80°, and pronation is within normal limits. A manual muscle test revealed a 4/5 with increased pain with wrist extension, and grip measurements, taken with a Jamar dynamometer, show the patient to have 65 pounds of grip strength of 65 pounds on the left and 100 pounds on the right.

At this stage in the examination, which of the following would be the most likely working hypothesis?

  1. Osteoarthritis of the radiocapitellar joint
  2. Radial tunnel syndrome
  3. Lateral elbow tendinopathy
  4. B and C

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