What would you tell the patient and his daughter to help them feel comfortable staying for treatment?

A 41-year-old male patient presents at the community walk-in clinic with complaints of severe elbow pain radiating into the forearm. His 13-year-old daughter is serving as a translator because her father is unable to speak English and understands only a few words in English. The daughter explains that he has been taking Tylenol to manage pain, but the pain is getting worse and is keeping him from working. You ask the daughter to describe the type of work her father does, and you notice she is hesitant to respond, first checking with her father. He responds, and she translates that he works in construction. Based on the response and the apparent concern, you suspect that the patient may be an undocumented worker. Further conversation reveals that several members of the family are working with the same local construction company.

You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?
While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?
Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
How is lateral epicondylitis treated?
When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?

Students response to case study you are to reply to:

The 41-Year-Old Patient Evaluation & Management.
You suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis?
Overuse syndrome describes a constellation of cumulative soft tissue trauma disorders that develop in the absence of acute injury. All major tissues in the musculoskeletal system are subject to overuse injuries. Overuse syndromes may be referred to as repetitive strain injury, chronic microtrauma, cumulative trauma disorders, soft tissue rheumatism, and work-related pain disorder; all these terms refer to syndromes that result in chronic localized pain and dysfunction. Lateral elbow pain is one of the most common sources of medical consultation for non-traumatic elbow disorders (Dunphy, 2019). The most frequent diagnosis is the tendinous disorder known as lateral epicondylitis (LE) or ‘tennis elbow’. However, many pathological conditions may mimic LE such as intra-articular plica, osteochondritis dissecans (OCD), radio capitellar arthritis, or posterolateral rotatory instability. The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception, and motor impairment. Most of the patients complain of pain located just anterior to, or in, the bony surface of the upper half of the lateral epicondyle, usually radiating in line with the common extensor mass. The pain can vary from intermittent and low-grade pain to continuous and severe pain which may cause sleep disturbance. It is typically produced by wrist and finger extensor and supinator muscle contraction against resistance. The pain lessens slightly if the extensors are stressed with the elbow held in flexion (Vaquero-Picado, 2016). The diagnostic tests indicated will vary depending on the body part involved. Radiographs are necessary with a history of trauma. A bone scan may be necessary to rule out stress fractures. Likewise, nerve conduction velocity studies can be ordered to rule out carpal tunnel syndrome or ulnar nerve entrapment at the elbow, but the results are usually negative. X-ray results are usually negative. MRI may help to visualize soft tissue injury (Dunphy, 2019).
While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?
The daughter is very concerned to get her father in trouble. The father might be an unauthorized worker and is an illegal immigrant who is only working cash jobs to avoid being arrested or deported. She is scared to reveal the name of the employer that hired her dad without legal papers as that can jeopardize future employment for her father and also might get her father deported if his immigration statues were to be revealed. According to Hacker (2015); Barriers to health care for undocumented immigrants go beyond policy and range from financial limitations to discrimination and fear of deportation.
Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?
An assessment of a patient presenting with lateral elbow pain should include grip strength using a hand-held dynamometer up to a loading where pain presents. This allows repeated measurements in comparison to the non-involved arm. Active, passive, and resisted movements of the elbow, forearm, and wrist must be performed – as well as the neurodynamic testing of the radial nerve to rule out spinal pathology. The special tests for testing medial and lateral ligament instability should also be included. It is useful to obtain an outcome measure; the patient-rated ‘tennis evaluation scale’ is a useful condition-specific tool. It spans from 0 (no pain or disability) to 100 (worst pain or disability), and factors in both pain and function. An abundance of special tests is available to assist with a diagnosis of LE. These include the Cozen, Maudsley, and Mills tests (Vaquero-Picado, 2016).
How is lateral epicondylitis treated?
Rest, ice, NSAIDs, and physical therapy are generally effective; corticosteroid injections and wrist splinting may be considered in some cases and have been shown to be effective for short-term relief of lateral epicondylitis. Physical therapy is more efficacious than steroid injection if symptoms persist longer than 6 weeks. splinting with an elbow strap may ease pain by exerting counterpressure on the soft tissue below the lateral epicondyle, or short-term use of a wrist splint may reduce pain from lateral epicondylitis. Corticosteroid injection may be necessary. Refer to physical and/or occupational therapy. These measures are effective in 80% of cases. If the patient is still symptomatic, referral to a specialist is warranted. Surgical procedures are a last resort (Dunphy, 2019).
When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?
The USA is home to more immigrants than any other country—about 46 million, just less than a fifth of the world’s immigrants. Immigrant health and access to health care in the USA vary widely by ethnicity, citizenship, and legal status. In recent decades, several policies and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmers, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation (Khullar, 2019). ;”> I will use therapeutic communication with the patient by showing my sympathy and understanding of his situation. I will also assure him that my role is to treat him and make sure he is getting better, that I am not a judge or a police officer; my job is only to treat his pain and give him the best care regardless of his immigration status. I can consult a social worker who might be able to apply for charity insurance for him to help him seek medical care until he fully recovers.
References.
Dunphy, M. L, Winland-Brown, E. J, Porter, O. B, & Thomas, J. D. (2019). Primary Care: Art and Science of Advanced Practice. (5th ed.). Philadelphia, PA: F.A. Davis Company. ISBN: 978-0-8036-6718-1.
Vaquero-Picado, A., Barco, R., & Antuña, S. A. (2016). Lateral epicondylitis of the elbow. EFORT open reviews, 1(11), 391-397.
Hacker, K., Anies, M., Folb, B. L., & Zallman, L. (2015). Barriers to health care for undocumented immigrants: a literature review. Risk management and healthcare policy, 8, 175–183. https://doi.org/10.2147/RMHP.S70173 (Links to an external site.)
(Links to an external site.)Khullar, D., & Chokshi, D. A. (2019). Challenges for immigrant health in the USA—the road to crisis. The Lancet, 393(10186), 2168-2174.