Concepcion's elbow pain

Concepcion is a short Mexican woman. By her darker, indigenous features I'd say she's from Michoacan. Her wine-colored uniform tells me she has just come her from work at the factory where she racks boxes of steel bars. Next to her is her teen age daughter, who helped her with any unanticipated staff who may not speak Spanish.

She is here today with pain in her left elbow. She hit the elbow against something 2 years ago and now it is painful. Her hand is becoming weak. She can no longer carry the 35 pound boxes of steel bars without dropping them. In fact, she did drop the box, and that is what prompted today's visit. But it is not just the left elbow, but it is also the right knee, which has the same burning pain, and the same shape of pain. By this I mean the same oval area just below the joint. They are the same pain for her.

From my cause-and-effect point of view, I ask her what she has been lifting. She has been lifting boxes, bending under the assembly line, kneeling, scrabbling around under the table getting parts...."everything" she explains. "Is it hard for you to lift a gallon of milk?" I ask. That's right, she can not longer lift it; it would slip out of her hand. "Has it been hurting since you hit the elbow 2 years ago?". No, in never hurt until now, she reveals.

I run my fingers over her forearm and elbow, looking for tender points, moving the joint. She's tender over an outcropping of bone called the lateral epicondyle, the little bump on the outside of the elbow. This is where a muscle starts that stabilizes and retracts the wrist. She has tennis elbow, not from tennis, but from lifting heavy boxes all day. I offer her an injection of medication. She agrees and I return in a couple of minutes with my little cocktail of local anesthetic, steroid, and nonsteroidal mediation; all told about 2 cc. I slowly inject the area, bathing the affected tendons in medication. I also give her a note for work restricting her lifting to no more than 15 pounds, and a brace to go around her forearm to reduce the tugging of the mucle anchored to that bone.

This is a simple straightforward case except for one detail. Why did Concepcion relate the pain to an impact 2 years ago rather than to the daily grind of her work? My observation is that a golpe or impact is considered to be a disturbance that can unleash illness to the same degree as a disturbance of hot and cold. Many immigrants will ask me, "Will that golpe on the head cause a brain tumor?" In this case, even though the fall or hit to her elbow was rather minor, and caused no pain for 2 years, it was the source of illness assumed by Concepcion.