Lаterаl Epicоndylitis (Tennis Elbоw) Bаckgrоund Overuse injury caused by repetitive wrist extension and forearm supination/pronation, leading to microtears and degeneration of the extensor carpi radialis brevis (ECRB) tendon at the lateral epicondyle. Not truly an “-itis” (inflammation); it is more often a tendinosis (degenerative process with angiofibroblastic hyperplasia). Common in racquet sports, carpenters, and repetitive gripping/extension activities. Symptoms Lateral elbow pain that worsens with wrist extension or gripping activities. Insidious onset; may progress over weeks to months. Pain can radiate down the forearm. Physical Exam Findings Point tenderness at the lateral epicondyle. Pain reproduced with resisted wrist extension (Cozen’s test). Pain with resisted middle finger extension (Maudsley’s test). Decreased grip strength due to pain. Full range of motion usually preserved. Making the Diagnosis Primarily clinical diagnosis based on history and exam. Imaging (US or MRI) only if atypical presentation or to rule out other causes. X-rays usually normal, may show calcification in chronic cases. Management Conservative treatment is first-line: Activity modification (avoid aggravating movements). Counterforce brace or wrist splint. Ice, NSAIDs (oral or topical). Physical therapy focusing on eccentric strengthening of wrist extensors. Other options if refractory: corticosteroid injections (short-term relief but higher recurrence), platelet-rich plasma (PRP) injections, or percutaneous procedures. Surgery only for persistent symptoms >6–12 months despite conservative therapy. QUESTION A 42-year-old carpenter presents with 3 months of progressive right elbow pain. The pain worsens when he lifts objects with his palm facing down. On examination, there is point tenderness over the lateral epicondyle and pain when he extends his wrist against resistance. Elbow range of motion is full. Which of the following is the most appropriate initial management?
Pоlymyаlgiа Rheumаtica (PMR) Backgrоund An inflammatоry rheumatic condition affecting older adults (age >50). Strongly associated with giant cell arteritis (GCA) — up to 15–20% of PMR patients develop GCA. Thought to involve systemic inflammation of bursae and periarticular structures. Symptoms Bilateral aching and stiffness in the shoulder and hip girdles, neck, and upper arms. Morning stiffness >1 hour is typical. Difficulty with activities such as combing hair, rising from a chair, or lifting arms. Systemic symptoms: fatigue, low-grade fever, weight loss, malaise. Physical Exam Findings Limited active range of motion due to pain and stiffness (passive ROM usually intact). No true muscle weakness, but pain limits function. Absence of synovitis (distinguishes PMR from RA). Making the Diagnosis Labs: markedly elevated ESR and CRP; CK is normal (distinguishes from myositis). Normocytic anemia may be present. Diagnosis is clinical — rapid response to low-dose corticosteroids is characteristic. Management First-line: low-dose oral corticosteroids (prednisone 10–20 mg daily). Symptoms usually improve within days to weeks. Slow taper once symptoms controlled; treatment duration often 1–2 years. Monitor for features of giant cell arteritis (new headache, jaw claudication, vision changes) — requires high-dose steroids to prevent vision loss. Adjunct: calcium + vitamin D supplementation; consider bisphosphonates if long-term steroids. Question A 72-year-old woman presents with 3 months of progressive aching in her shoulders and hips. She reports difficulty combing her hair and rising from a chair due to stiffness and pain, especially in the morning. Exam shows limited active range of motion of the shoulders and hips, but muscle strength is intact when tested after passive movement. Laboratory studies reveal elevated ESR and CRP. Which of the following additional findings most clearly distinguishes polymyalgia rheumatica from an inflammatory myopathy such as polymyositis?