It turned out to be elbow pain of course.
Background - elbow pathologies we learnt about were medial/lateral epicondilagia, MCL sprain (little leagure's elbow), olecranon bursitis and radial head dislocation in children.
This patient had posterior/medial pain from 10cm above to 5cm below elbow, exacerbated by elbow extension and driving (hands on top of steering wheel). It began with ballistic extension activities (punches/push-ups) in a martial arts class.
From the beginning it wasn't fitting into the typical presentations we're familiar with from lectures. This was further confirmed with special objective tests, eg for golfer's elbow: medial epicondyle palpation, finger/wrist flexor stretch, resisted wrist flexion and pronation were all negative.
Neural involvement was excluded by pain characteristics, neck screening, NTPTs and ulnar nerve palpation posterior to medial epicondyle.
Not knowing what to look for next I palpated the area and found a very distinct triceps 'knot' that reproduced the pain.
It turned out to be a simple triceps strain. Triceps length, pain levels, and elbow extension ROM all improved significantly with some massage and hold-relax! Also, the 'knot' nearly completely disappeared. (Other advice/HEP/education were also conducted.)
I tend to under-estimate the value of palpation as an assessment tool, probably because it seems so much easier than the specific tests we learn in labs.
This experience has re-affirmed to me its usefulness, especially in situations where the source of pain is difficult to establish.
1 comment:
Great reminder that palpation is a useful tool for assessment. Your right sometimes we underestimate its use in assessment. However lets face it, everything that is in the assessment procedure is there for a reason, but sometimes we need reminding of why that is.
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