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% Document Info
\author{bee.f (bee.f)}
\pdfinfo{
  /Title (5002-case-2.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 2 Cheat Sheet)
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        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 2 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38463/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 11th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{document}
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- 48 y.o. lawyer\{\{nl\}\}- Lateral epicondyle w/ radiation into the forearm\{\{nl\}\}- Onset 2 weeks ago after doing DIY using hammer} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{- Sharp, aching \& burning\{\{nl\}\}- 7/10 at worst, 2/10 at best\{\{nl\}\}- Progressively getting worse\{\{nl\}\}- {\bf{Timing:}} elbow stiff in morning, aware of it most of the time but worse w/ certain activities} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- {\bf{AF:}} gripping \& lifting (e.g. briefcase) or shacking hands\{\{nl\}\}- {\bf{RF:}} Rest \& ibuprofen} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findingscal}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- Very loose handshake, R elbow appears slightly swollen compared to L w/ no obvious deformity} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Reflexes}}\{\{nl\}\}- 1+ biceps \& triceps bilaterally\{\{nl\}\}- 2+ brachioradialis bilaterally} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{ROM}}\{\{nl\}\}- {\bf{AROM:}} Cx pain \& restriction on R rotation\{\{nl\}\}- {\bf{PROM:}} R resisted pronation + extension caused pain on R lateral epicondyle\{\{nl\}\}- {\bf{Grip strength:}} caused pain on R lateral epicondyle} \tn 
% Row Count 9 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Myofascial \& joint findings}}\{\{nl\}\}- Tight extensors\{\{nl\}\}- Tender \& containing trigger points on R\{\{nl\}\}- Restricted radial head} \tn 
% Row Count 12 (+ 3)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working Dx:}}\{\{nl\}\}- Wrist extensor tendinopathy (aka lateral epicondylalgia / tennis elbow)} \tn 
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% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Hx:}}\{\{nl\}\}- Acute onset associated with repetitive use\{\{nl\}\}- Some signs that it could still be inflammatory {\bf{{\emph{(tendonitis)}}}}\{\{nl\}\}→ at 2 weeks duration it'll be moving towards a {\bf{{\emph{tendinosis}}}} (degeneative)} \tn 
% Row Count 7 (+ 5)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{What suggests this isn't a wrist extensor strain / sprain?}}\{\{nl\}\}- Relieved by ibuprofen} \tn 
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\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{What suggests this isn't a radial nerve entrapment?}}\{\{nl\}\}- Character of pain isn't neurological\{\{nl\}\}- Mechanical aggravating \& relieving factors\{\{nl\}\}- PROM findings suggest complaint is muscular} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{What suggests this isn't RA?}}\{\{nl\}\}- Clear mechanical onset\{\{nl\}\}- No symmetrical synovitis of the small joints of the hands \& feet} \tn 
% Row Count 16 (+ 3)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{What suggests this isn't elbow arthropathy?}}\{\{nl\}\}- Elbow OA most commonly affects the radiocapitellar joint\{\{nl\}\}- Pain is at the lateral epicondyle\{\{nl\}\}- Clear mechanical onset\{\{nl\}\}- ROM findings which suggest muscular involvement} \tn 
% Row Count 21 (+ 5)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Risk factors for poor prognosis:}}\{\{nl\}\}- Worsening pain\{\{nl\}\}- Prevented from exercising \& performance of activities of daily living (ADLs)\{\{nl\}\}- Aggravated by simple use (grip)} \tn 
% Row Count 25 (+ 4)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Dx of elbow pain}}\{\{nl\}\}{\bf{- Posteior:}} {[}1{]} Olecranon bursitis - inflammation of the bursa sac {[}2{]} Triceps tendinitis - inflammation of the tendon {[}3{]} Radial head fracture {[}4{]} Osteoarthritis - DJD\{\{nl\}\}{\bf{- Anterior:}} {[}1{]} Biceps tendinitis - inflammation of the tendon {[}2{]} Elbow flexor tendinitis - inflammation of the tendons {[}3{]} Ulnar collateral ligament (UCL) injury - medial ligament injury (throwing athletes) {[}4{]} Osteochondritis dissecans (OCD) - piece of bone \& cartilage within the elbow breaks loose\{\{nl\}\}{\bf{- Lateral:}} {[}1{]} Tendinopathy of wrist extensor origin (tennis elbow) - inflammation of the tendon {[}2{]} Radial tunnel syndrome - compression of radial nerve as it passes through the forearm muscle {[}3{]} Lateral ulnar collateral (LUC) ligament- lateral side ligament injury\{\{nl\}\}{\bf{- Medial:}} {[}1{]} Golfer's elbow (medial epicondylitis) - inflammation of the tendon {[}2{]} Ulnar nerve entrapment - ulnar nerve compression as it passes through cubital fossa {[}3{]} Medial collateral ligament (MCL) injury - medial side ligament injury} \tn 
% Row Count 21 (+ 21)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Pathophysilogy of tendinopathy}}\{\{nl\}\}{\bf{- Overuse:}} microscopic damage that the body is unable to repair quickly enough\{\{nl\}\}{\bf{- Age-related changes:}} tendons becoming less elastic \& more prone to injury, degenerative changes \{\{nl\}\}{\bf{- Mechanical stress:}} e.g. repetitive motion throwing a ball can cause stress on tendon of the shoulder \& lead torotaor cuff tendinopathy\{\{nl\}\}{\bf{- Inflammatory response:}} tendon tissue is damaged, triggering inflammatory response, aka pain \& swelling in affected area\{\{nl\}\}{\bf{- Genetic factors:}} e.g. certain genes have been associated w/ increased risk of developing achilles tendinopathy\{\{nl\}\}{\bf{- Other:}} diabetes \& rheumatoid arthritis} \tn 
% Row Count 35 (+ 14)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Difference between tendonitis and tendinosis}}\{\{nl\}\}{\bf{- Tendonitis:}} (tendinitis) acute condition that results from inflammation of the tendon; caused by overuse, repetitive motion, or injury; {\bf{symptoms:}} pain, swelling, \& tenderness in the affected area;{\bf{treatment:}} rest, ice, compression, \& elevation (RICE), as well anti-inflammatory medications, mechanical therapy, \& sometimes corticosteroid injections\{\{nl{]}{]}{\bf{- Tendinosis:}} chronic condition that results from degeneration of the tendon tissue; caused by repetitive motion or overuse over long period of time, w/o adequate time for rest \& recovery; doesn't involve significant inflammation; {\bf{symptoms:}} pain, stiffness, \& weakness in the affected area; {\bf{treatment:}} manual therapy to strengthen the affected area \& improve flexibility, shockwave therapy, platelet-rich plasma injections, or surgery (severe cases)} \tn 
% Row Count 18 (+ 18)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Management}}\{\{nl\}\}{\bf{6 week plan:}}\{\{nl\}\}- Heat/ice to relieve pain\{\{nl\}\}- Rest the arm \& avoid aggravating sports/work\{\{nl\}\}- Consider using orthosis (wrist brace)\{\{nl\}\}- Analgesia for symptom relief: paracetamol or topical NSAIDs (ibuprofen gel)\{\{nl\}\}{\bf{If no response to treatment after 6 weeks:}}\{\{nl\}\}- Reassess pt \& consider alternative Dx\{\{nl\}\}- Manual therapy: stretching \& strengthening exercises for the wrist \& forearm extensors, eccentric muscle training, massage, \& ultrasound therapy} \tn 
% Row Count 28 (+ 10)
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{What are clinical prediction rules?}}\{\{nl\}\}- CPRs help guide clinical decision-making by providing standardised approach to pt assessment \& management\{\{nl\}\}- Based on research \& statistical analysis of clinical data to identify patterns \& factors that are associated w/ specific diagnoses, outcomes, or responses to treatment} \tn 
% Row Count 35 (+ 7)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning outcomes (cont)}}  \tn
% Row 5
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical prediction rule, success probability managing pts w/ lateral epicondyalgia using mobilisation w/ movement \& exercise}}\{\{nl\}\}- Score of 0-4 indicates low success probability\{\{nl\}\}- Score of 5-7 indicates a moderate success probability\{\{nl\}\}- Score 8-10 indicates high success probability} \tn 
% Row Count 6 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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