Tennis Elbow Ppds

8/13/2019 Tennis Elbow Ppds

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LATERAL EPICONDYLITIS

(TENNIS ELBOW)

By :Ida Yuanita, MD


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Pathophysiology

Inflammation at the muscular origin of the

Extensor Carpi Radialis Brevis (ECRB)

microtears of the tendonsubsequent

fibrosistissue failure

Less commonly the attachment of the

Extensor Carpi Radialis Longus (ECRL),

Extensor Digitorum Communis (EDC), orExtensor Carpi Ulnaris (ECU) are involved

Rene Calliet, Soft Tissue Pain and Disability, 2nded


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Sex

men and women with equal frequency

Age

most often occurs between 3rd and 5th

decades of life


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Clinical

History

The patient usually describes a gradual

onset of lateral elbow pain, which

is characterized as follows:

The aching pain generally increases with

activity

Symptoms are typically unilateral


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Physical

Most commonly, the examination reveals

localized tenderness to palpation just

distal and anterior to the lateral

epicondyle. Other symptoms include thefollowing:

Pain increases with resisted wrist

extension, especially with the elbow inextension


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The patient may have a weakened grip on

the affected side

Elbow range of motion (ROM) is typically

normal


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Causes

Lateral epicondylitis is an overusesyndrome generally caused by repetitive

use of the wrist extensors or sustained

power gripping


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Workup

Laboratory Studies

Not needed

Imaging Studies

usually are not necessary, but

tendinopathies can be visualized

with magnetic resonance imaging (MRI)

and with ultrasonography


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Other Tests

Electrodiagnostic studies may help to

determine whether other causes of lateral

elbow pain, such as cervical radiculopathy

or posterior interosseous nerve palsy, are

present


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Treatment

Rehabilitation Program

Physical Therapy

Acute stage goal of treatmentto reduce pain and

inflammation.

A wrist splint used during activities can behelpful, because it places the extensor

muscles in a position of rest and prevents

maximal muscle contraction


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Sub acute stage

emphasizethe restoration of function of

the involved muscle group. Flexibility,strength, and endurance of the wrist

extensor muscle group.

ROM for wrist flexion/extension andpronation/supination

Strength and grip training


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Chronic stage

scapular stabilization should be addressed

to prevent overuse of the wrist extensorsduring activities.

Sports-specific training should also be

included in the rehabilitation program, ifappropriate.


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Occupational Therapy

Job and recreational tools and/or equipment

may need to be modified, especially ifrepetitive gripping is required

Medical TreatmentNSAIDs, steroid injection

Surgical Intervention

For cases of refractory lateral epicondylitis,

surgical resection of the lateral extensor

aponeurosis might be considered.


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Data Base IdentityName : Mr. M

Age : 38 yo

Address : Ngagel Baru, Surabaya

Occupation : laborer at wire factory

Status : married

Religion : Moslem

Patient was referred from internal oupatient

clinic with pain on the right elbow


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Chief Complain

Nyeri siku kanan

History of Present Illness

Pain of the right elbow has been felt since2 months ago

Pain as a sharp pain, increase with such

an activity as lifting or taking a bath and

was relieved by taking analgesic drugs.

There was no numbness, tingling

sensation and weakness on his hand


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He was still able to do his daily activities

but feeling pain.

He has worked in the wire factory for 14

years, lifting and pulling the wire (80kg); 9

hours/day with 1 hour break

History of Past Illness

No history of trauma, DM

He went to clinic and he was given Nadiklofenac , but he still feels pain


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Physical Examination

General Examination (12/10/09)

CM, ambulatory independent, gait N, righthanded

BP : 120/70 mmHg, HR : 88 x/minute

Weight : 65 kg ; BH : 170 cm, BMI=22,4


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Head & Neck : no anemia, icterus,

cyanosis & dyspneu

Thorax : Cor : S1S2 sound, murmur -

Pulmo : vesiculer, wheezing -/-

, ronchi -/-

Abdomen : Meteorismus -,Hepar / Lien : unpalpable

Extremities : warm acral


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Physiatric ExaminationCervical ROM MMT

Flexion F (0-450) 5

Extension F (0-450) 5

Lateral Flexion F/F (0-450) 5/5

Rotation F/F (0-600) 5/5

Trunk ROM MMT

Flexion F(0-450

) 5Extension F (0-300) 5

Lateral Flexion F/F (0-350) 5/5

Rotation F/F (0-450) 5/5

S O


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Shoulder ROM MMT

Flexion F/F (0-1800) 5/5

Extension F/F (0-800

) 5/5Abduction F/F (0-1800) 5/5

Adduction F/F (0-450) 5/5

Ext. Rotation F/F (0-450) 5/5Int. Rotation F/F (0-550) 5/5

Elbow ROM MMT

Flexion F/F (0-1500) 5/5

Extension F/F (1500-0) 5/5

Forearm supination F/F (0-800) 5-/5

- 0 - W i ROM MMT


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Wrist ROM MMT

Flexion F/F (0-800) 5/5


) 5-/5Radial deviation F/F (0-200) 5-/5

Ulnar deviation F/F (0-300) 5-/5

Fingers ROM MMTFlexion

MCP F/F (0-900) 5/5

PIP F/F (0-1000) 5/5

DIP F/F (0-900) 5/5

Extension F/F (0-450) 5-/5

- 0


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Thumb ROM MMT

Flexion

MCP F/F (0-500) 5/5

IP F/F (0-900) 5/5


Abduction F/F (0-500) 5/5


Opposition 5-/5

Hi ROM MMT


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Hip ROM MMT

Flexion F/F (0-1250) 5/5


) 5/5Abduction F/F (0-450) 5/5


Ext. Rotation F/F (0-800) 5/5Int. Rotation F/F (0-800) 5/5

Knee ROM MMT

Flexion F/F (0-1350) 5/5


A kl ROM MMT


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Ankle ROM MMT

Plantar Flexion F/F (0-450) 5/5

Dorsi Flexion F/F (0-300

) 5/5Inversion F/F (0-350) 5/5

Eversion F/F (0-250) 5/5

Toes ROM MMTFlexion

MTP F/F (0-300) 5/5

IP F/F (0-500) 5/5



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Big Toe ROM MMT

Flexion

MTP F/F (0-250) 5/5

IP F/F (0-250) 5/5



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Neurological Examination

Cranial nerve I-XII : normal

Physiological Reflex: BPR +2/+2 KPR +2/+2

TPR +2/+2 APR +2/+2 Pathological Reflex : Babinski -/- HT -/-

Sensory deficit : -


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Localize status: Right elbow

I : swelling -, redness -, deformity -P : tender point at right lateral epicondyle

Special test :Yergason test : -/-

Tinnel sign : -/-

Thomson test : +/-


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Supporting Examination

X-ray elbow D/S : no abnormality


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Diagnosis : Lateral epicondylitis dextra

Functional diagnosis :

Impairment : Lateral epicondylitis dextra

Disability : difficult to lift objects and

take a bath

handicapped : -

Problem List :

Surgical : -

Medical : Lateral epicondylitis dextra


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Rehabilitation medicine

R1 (Ambulation) : -

R2 (ADL) : difficult to liftobjects and take a bath

R3 (Communication) : -

R4 (Social) : -

R5 (Psychological) : -

R6 (Vocational) : -

R7 (Others) : Lateral

epicondylitis D

Pain (VAS 6)

Pl i


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Planning

Surgical : -

Medical : continue renadinac from internaloutpatient clinic

Rehabilitation medicine :

PDx : -

PTx : USD at area of right elbow

(origin of ECRB), Freq. 3MHz, contonuous

mode, intensity 1,5 W/cm2

, duration 8 min. PMx : Clinically

PEX : HE / HEP


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Summary

Reporting a patient, 38 y.o man was referred

from internal outpatient clinic with pain on

the right elbow.

Chief Complain : Nyeri siku kanan

Pain of the right elbow has been felt since 2

months ago. Pain as a sharp pain,

increase with such an activity as lifting or

taking a bath and was relieved by takinganalgesic drugs. There was no numbness,

tingling sensation and weakness on her

hand


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He was still able to do his daily activities but

feeling pain. He has worked in the wire

factory for 14 years, lifting and pulling thewire (80kg); 9 hours/day with 1 hour break

From physical examination was found

tender point at right lateral epicondyle andThomson test + at the right elbow

We plan to treat it by giving USD at area of

the right elbow (origin of ECRB), Healtheducation and Home Exercise Program


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THANK YOU


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ew rea men or a era


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ew rea men or a eraEpicondylitis

Recent research at NISMAT presented at the 2009 American Orthopaedic Society for Sports Medicine

Meeting suggests an effective treatment for tennis elbow using wrist exercises with an inexpensive rubber

b (th Th B d Fl B )

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Tennis Elbow Ppds