HISTORY: 57 year old female golfer complains of left elbow pain for 2 years. Initially pain started on medial side of elbow, but over the past 2 months has had pain on the lateral elbow. Patient also notes a burning sensation over the past 2 weeks in her mid-forearm.
PHYSICAL EXAMINATION: Swelling noted over the medial epicondyle. Tenderness noted over the medial and lateral epicondyles as well as distal to the lateral epicondyle. Full range of motion of wrist and elbow, but decreased strength on wrist flexion, extension, supination, pronation and resisted middle finger extension.
DIFFERENTIAL DIAGNOSIS:
- Epicondylitis
- Radial Tunnel Syndrome
- Osteoarthritis
- Elbow Synovitis
TEST AND RESULTS: Left Elbow anterior-posterior and lateral radiographs:
-no fractures, dislocations, arthritis.
MRI Left Elbow
-small joint effusion, contusion of lateral epicondyle, T2 hyperintense signal of extensor carpi radialis brevis tendon
Nerve Conduction Study of Left arm:
-Posterior Interosseus Nerve Entrapment
FINAL WORKING DIAGNOSIS: Radial Tunnel Syndrome with lateral and medial epicondylitis.
TREATMENT AND OUTCOMES: 1. Corticosteroid injection of medial epicondyle.
2. Corticosteroid injection of lateral epicondyle.
3. Wrist brace for wrist immobilization for 4 weeks.
4. Forearm strap.
5. Physical Therapy.
6. Mild improvement after corticosteroid injections. No improvement with brace, forearm strap or physical therapy. Patient has not returned to golf. Patient not interested in surgery.
