Case 4

A 17-year old athlete requests an urgent appointment to see you because of bilateral lateral elbow pain (right greater than left). The pain has been present for three months and has coincided with volleyball season. He is very anxious to continue playing because his team is doing well this season and is likely to win the regional championships. In addition, he is aware that there are some university athletic scouts who are interested in his performance. He has applied ice after several games with some improvement and takes the occasional ibuprofen tablet if the pain is severe. He is otherwise healthy with no other active musculoskeletal issues.

On physical exam you notice that the patient has no deformity, redness or swelling about the elbows. He has full range of motion of both shoulders, elbows and wrists however resisted wrist extension on the right reproduces the elbow pain. He is locally tender over the lateral aspect of the elbow.

 

Image credit: milesgehm

Questions for discussion:

1. What is the most likely diagnosis based upon this information?
2. What anatomic structures may be abnormal in this individual?
3. What imaging would be helpful and what would you expect to see?

 

 

 

 

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