USMLE Forum Archives - USMLE Step 2 CK - Elbow pain
Elbow pain
laparotomy - 01-26-08 11:04
A 52 year old female presents to you with severe right elbow pain following a fall on an icey pavement. Physical examination reveals excruciating pain on the right elbow with reduced range of motion. There is no swelling, deformity or sign of any hematoma. You order an xray which reveals no bony injury. You decide to give her analgesia but she says she is allergic to all analgesia except morphien.
What is your diagnosis?
What is your next step in management?
laparotomy - 01-26-08 11:04
A 52 year old female presents to you with severe right elbow pain following a fall on an icey pavement. Physical examination reveals excruciating pain on the right elbow with reduced range of motion. There is no swelling, deformity or sign of any hematoma. You order an xray which reveals no bony injury. You decide to give her analgesia but she says she is allergic to all analgesia except morphien.
What is your diagnosis?
What is your next step in management?
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#1
Re: Elbow pain radhamesramos - 01-26-08 15:58 I send her to do another X-Ray, this time a dynamic profile to see a fracture or a luxation of the head of the radius.
Treatment is immobilisation anyways
#2
Re: Elbow pain 8401glacieres - 01-26-08 22:06 Does she fit into group of patients who have drug seeking attitude?
#3
Re: Elbow pain
laparotomy - 01-27-08 04:41 
posted by 8401glacieres on 01-26-08 22:06
Does she fit into group of patients who have drug seeking attitude?
Does she fit into group of patients who have drug seeking attitude?
I think you are right. It is always suspicious when a patient is allergic to all analgesia except morphein. The other thing is that even if a patient does have a fracture that is seen on xray Morphein is not the usual analgesia. We give something less strong.
#4
Re: Elbow pain radhamesramos - 01-28-08 12:07 Good case! that was my approach if haven't found anything else on the other x-rays
#5
Re: Elbow pain laparotomy - 01-28-08 15:18 posted by radhamesramos on 01-28-08 12:07
Good case! that was my approach if haven't found anything else on the other x-rays
Good case! that was my approach if haven't found anything else on the other x-rays
#6
Re: Elbow pain yarub14 - 01-28-08 17:28 Well, this pt seems to be showing signs of Malingering (seeking meds).. Next step would be a Psych eval.. that s my guess, please correct me...
#7
Re: Elbow pain laparotomy - 01-29-08 03:32 Exactly, treatment options may include psychotherapy, family therapy, cognitive behavioural therapy, or pharmacotherapy. It is important to also inform the nurses on the ward. Usually if these patients are confronted then they go to other facilities and try the same. It is however unethical to blacklist them and call other fascilites to warn them because they may once really have a true disease or injury (eg fracture of the humerus) and there is a danger we may miss it.
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