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Posted: Feb 14 2021 #(C101718)
B

Bony Spur at the Humeral Lateral Epicondyle in 40M

HPI

A 40-year-old male presents to your office with complaints of lateral elbow pain after heavy weight lifting. He denies feeling a "pop" sensation at the time but admits to local tenderness over the lateral distal humerus. Denies numbness or tingling

PMH

No significant past medical history

PE

Localized examination reveals tenderness over the lateral distal humerus. No ecchymosis or erythema is appreciated. Full flexion, extension, pronation and supination of the elbow. Endorses some discomfort with resisted wrist extension and forearm supination. Neurovascularly intact

Poll
1 of 8
1. In addition to the plain film radiographs, would you obtain any further imaging to guide your treatment?
No - current radiographs are sufficient
55%
5/9
Yes - additional radiographs (XR)
0%
0/9
Yes - CT scan
22%
2/9
Yes- MRI
22%
2/9
Yes -XR + CT
0%
0/9
Yes - XR + MRI
0%
0/9
Yes - CT + MRI
0%
0/9
Yes - XR + CT + MRI
0%
0/9
Outside my area of expertise - best if I don't vote
0%
0/9
2. How would you classify this finding?
Lateral Supracondylar Spur Process
75%
6/8
Exostosis
25%
2/8
Ossified lateral intermuscular membrane
0%
0/8
Osteochondromas
0%
0/8
Other
0%
0/8
Outside my area of expertise - best if I don't vote
0%
0/8
3. Would you perform a biopsy of this lesion?
No
100%
7/7
Yes
0%
0/7
Outside my area of expertise - best if I don't vote
0%
0/7
4. How would you definitively manage this patient?
Nonoperative
85%
6/7
Operative
0%
0/7
Outside my area of expertise - best if I don't vote
14%
1/7
5. If you choose Nonoperative management, what technique would you use?
I would not choose Nonoperative management
0%
0/6
No intervention needed
0%
0/6
Cortisone injection only
0%
0/6
Stretching only
0%
0/6
Splinting only
16%
1/6
PRP injection only
0%
0/6
Physiotherapy only
0%
0/6
Combination of techniques listed above
50%
3/6
Outside my area of expertise - best if I don't vote
33%
2/6
6. If you choose Nonoperative management with failure of symptom improvement, how long until you would consider surgical intervention?
I would not choose Operative management
33%
2/6
<6 weeks
0%
0/6
6-12 weeks
16%
1/6
3-6 months
33%
2/6
7-9 months
16%
1/6
10-12 months
0%
0/6
>1 year
0%
0/6
7. If you choose Operative management, what technique would you use?
I would not choose Operative management
20%
1/5
Resection of the lesion only
0%
0/5
Release and debridement of ECRB origin only
60%
3/5
Combination of the techniques listed above
20%
1/5
Other
0%
0/5
Outside my area of expertise - best if I don't vote
0%
0/5
8. If you choose Operative management, what approach would you use?
I would not choose Operative management
0%
0/5
Direct lateral
20%
1/5
Lateral Kocher
40%
2/5
Lateral Kaplan
40%
2/5
Posterior
0%
0/5
Outside my area of expertise - best if I don't vote
0%
0/5
PROCEDURE #1

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