Article

Elbow pain can originate from many sources yet have
similar signs and symptoms, thereby presenting differential diagnostic
challenges. The elbow is commonly injured, thus requiring all clinicians to
possess excellent diagnostic skills. CASE DESCRIPTION:
A 24-year-old woman
slipped and fell on her outstretched left hand, experiencing immediate elbow
pain. The same day radiographs were deemed negative by her orthopedist, who
referred her to physical therapy with the diagnoses of elbow sprain and
contusion. Immediately after examining the patient, the physical therapist
consulted with the referring orthopedist. The decision to consult was based on:
the mechanism of injury, pain severity out of proportion to the referred
diagnoses, significantly limited ROM, abnormal joint end feels, exquisite pain
with tactile and tuning fork bony palpation, and positive elbow extension test.
OUTCOMES: The treating physical therapist shared the above-noted findings with
the orthopedist, who overruled and recommended continuing the original
prescription of non-steroidal anti-inflammatory medication and physical therapist
treatment for four weeks.
The physical therapist's updated plan of care at four
weeks noted the patient's continued reports of pain, functional limitations, and
disability. A magnetic resonance image (MRI) was then ordered, revealing a radial
head fracture. DISCUSSION:
A thorough history and examination by the physical
therapist led to clustering of signs and symptoms, allowing for the development
of a differential diagnosis list which included occult radial head fracture. All
clinicians should be prepared to screen for complex conditions. Timely diagnosis
and improved outcomes for clinically complex patients are increasingly necessary
in contemporary healthcare reimbursement models.

Langue : ANGLAIS