Case 55: Geoff Sharp

INSTRUCTIONS FOR THE DOCTOR

This is a short case.

Please take a history from Geoff and conduct an appropriate focused examination. Outline to the facilitator your findings and suggestions for management.

The following information is on his medical record:

• Past medical history

• Nil significant

• Medication

• Nil

• Allergies

• Nil recorded

• Immunisations

• Up-to-date

• Social history

• Nil recorded.

INSTRUCTIONS FOR THE PATIENT, GEOFF SHARP

You are a 54-year-old teacher. Normally you are fit and well and do not go to the doctor. For the last few weeks, you have noticed a pain in your right elbow. This makes it hard to carry books at school and you experience pain when trying to pour the kettle or open doors.

You have not sustained an injury to the elbow but do remember that the pain came on after you had spent the weekend gardening.

You have tried some paracetamol but it did not make much difference.

Clinical examination findings

You will demonstrate pain on pressure over the right lateral epicondyle and on active extension of the wrist. You have tennis elbow—extensor tendinopathy.

The following information is on your medical record:

• Past medical history

• Nil significant

• Medication

• Nil

• Allergies

• Nil recorded

• Immunisations

• Up-to-date

• Social history

• Nil recorded.

SUGGESTED APPROACH TO THE CASE

Establish rapport

Open questions to establish Geoff’s ideas, concerns and expectations.

Specific questions

Duration of pain

Onset of pain

Precipitants of pain

General health

Treatment so far

Impact of problem on Geoff’s life

Request permission to examine.

Examination

Ensure full view of both arms

Look

• — Exclude deformity or swelling

• — Muscle mass

Feel

• — Elicit tenderness

• — Exclude temperature increase in right arm

Move

• — Test range of movement of elbow joints—active, then passive

• — Flexion, extension and pronation/supination

• — Test movement against resistance

Pain is maximal on wrist extension against resistance.

Diagnosis

Tennis elbow—extensor tendinopathy.

Management

Education about the diagnosis

Rest

Range of treatment options starting with the least invasive^...