Review Question - QID 212150

A 38-year-old female employee of a city Parks and Recreation department in a small Mid-Western town presents with persistent right elbow pain. Her symptoms are made worse when she removes thick brush or lifts heavy objects in the care of her small municipal pony. For the last 3 years, under the care of a rheumatologist, she has taken an appropriate disease-modifying anti-rheumatoid drug (DMARD) regimen. Despite this, on exam, she has a pronounced joint effusion, elbow flexion arc of 45°, and crepitus with forearm rotation. Her elbow radiographs reveal preservation of her joint ulnohumeral space. Her hand surgeon has recommended a synovectomy with radial head resection. Which of the following factors does not represent an indication to perform a synovectomy with or without radial head resection?