Problem:
It is late June. You are a primary care osteopathic physician interviewing Andrew Wilson, a 17-year old male baseball pitcher who has sustained an injury to the right elbow. You suspect he has an ulnar collateral ligament (UCL) problem common to pitchers, often in adolescents, called a Tommy John injury. According to Zaremski et al, "Nonsurgical management was most common in the youngest athletes (age 11-13 years, 100.0% of total injuries; age 14-16 years, 71.4% of total injuries"81 when looking at the epidemiologic trends of surgery for the condition. The option of rehabilitation for Andrew's sprain is the preferred option in your practice in order to repair the sprain during the off-season, as the majority of adolescents seen in your clinic with a sprain are able to rehabilitate the ligament without surgical need. An MRI report does not show a tear in the UCL.
Instructions:
1. Review the Assessment Phase of Patient Care section of Chapter 10. Provide a list of 5 key questions to ask the patient regarding the inciting event, location, severity, duration, and quality of the pain, and the patient's motivation to do more intense or lighter therapy. One question should include how his activities are limited and what movement he was doing at the time that he sustained the injury. Be sure to include open-ended questions that prompt the patient to give more than a yes/no answer.
2. Provide a PPAARE question regarding manual therapies for UCL injuries and perform a search of the literature.
3. Provide paragraph describing your search strategy and results, including a references list of the most relevant, best evidence, articles to address your PPAARE question.
4. Provide paragraph summarizing the information from the search to prepare to discuss the treatment options with the patient.