ABIM Rheumatology Practice Tests & Exam Prep Questions - Features

why rrect: the vignette is classic for lateral epicondylitis: insidious lateral elbow pain after repetitive wrist extension activities (gardening), focal tenderness just distal to the lateral epicondyle, pain with resisted wrist extension and with gripping, preserved elbow range of motion, and normal radiographs. lateral epicondylitis reflects tendinopathy of the extensor carpi radialis brevis and related tendons; diagnosis is clinical. initial management includes activity modification, eccentric strengthening, nsaids or topical nsaids, and consideration of physiotherapy; corticosteroid injections provide short-term pain relief but higher recurrence rates, and prp or extracorporeal shockwave therapy may be considered for refractory cases.

why the other answers are incorrect:

• cervical radiculopathy: would more likely have neck pain, radicular pattern of sensory changes or weakness in a c6/c7 distribution, and positive spurling test; focal point tenderness at the lateral epicondyle with pain on resisted wrist extension is not explained by radiculopathy.
• elbow osteoarthritis: usually presents with progressive loss of motion, crepitus, morning stiffness and characteristic radiographic joint space narrowing and osteophytes; the normal radiographs and preserved rom argue against oa.
• radial tunnel syndrome: can cause lateral forearm pain but typically pain is located more distal and lateral to the epicondyle and is worsened by resisted supination or long finger extension; motor weakness of the posterior interosseous nerve may be present. the classic point tenderness and pain with resisted wrist extension favor tendinopathy rather than nerve entrapment.