Case study – Tennis Elbow Suresh Bandaru Locum ESP, MCATS Spinal service- Lewisham NHS Trust, Lewisham, London. Th e biceps brachii originates via 2 heads proximally at the shoulder: the long head from the supraglenoid tuberosity of the scapula, and the short head from the cora-coid process of the scapula. Tennis elbow is a pain focused on the outside of your arm, where your forearm meets your elbow. Richards. Lateral elbow tendinopathy (LET), known commonly as tennis elbow, is a highly prevalent and painful condition affecting the lateral side of the elbow [].The exact aetiology and pathogenesis are currently unknown and are the source of much debate [2,3,4,5,6,7], but some element of overuse of the common forearm extensors is believed to be implicated. The aim of this review is to provide an introduction to US imaging of the elbow, and to summarize findings as-sociated with basic rheumatic and orthopedic disorders. Affiliations. AnthonyJ. Tennis elbow occurs when there is a problem with the tendon (called the extensor carpi radialis brevis muscle tendon) that attaches to the outside part of the elbow bone called the lateral epicondyle, thus giving tennis elbow the medical name 'lateral epicondylitis.' However, there are treatments that can be used to improve your symptoms and speed up your recovery. Tennis elbow assessment tests. Search for articles by this author. It is the second most commonly … | PowerPoint PPT presentation | free to view Tennis Elbow symptoms are easily diagnosed by your Doctor, perhaps with X-ray or ultra-sound being used to aid diagnosis. D.R. tennis elbow) Lateral epicondylitis involves the inflammation of the extensor tendons at their insertion point secondary to overload injury (e.g. Joint Motion and Function Assessment. Tennis elbow (lateral epicondylitis) is an overuse injury of a tendon that connects the forearm muscles to the lateral epicondyle (a knobby bump at the bottom of the humerus bone of the upper arm). Complaints can also be skin related with regards to other medical conditions, such as psoriasis and rheumatoid arthritis. The early goal of a therapeutic exercise program is to promote muscle endurance and improve resistance to repetitive stress. Carrying angle should be assessed for possible malunion and, if full extension is not achievable, flexing the contralateral elbow to same degree to make a comparison should assist the examiner. Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment. What causes Tennis Elbow . 1, 5. Physical examination of the spine and extremities. In tennis elbow compared to controls, hand/wrist and shoulder strength and extensor carpi radialis (ECR) activity were reduced (p < 0.05), while fatigue was normal. Swinson. A professional therapist may perform a number of specific assessment tests to help diagnose lateral elbow pain. (2005). In some cases, tennis elbow can persist for more than a year. The assessment of the arthritic elbow is crucial in treatment planning. 43 The above symptom is associated with a clinical diagnosis of lateral elbow tendinopathy (LET), also known as tennis elbow or lateral epicondylalgia. 2010 Feb 2. Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment. It's time to turn it around, freshen up the area of our brain that looks after the elbow, and master your assessment, diagnosis and treatment of elbow pain. 2008 Apr. Tennis elbow is a chronic condition that can be challenging to treat. Use the opposite hand to press the stretching hand back towards your body and hold for 15–30 seconds. It's important that you rest your injured arm and stop doing the activity that's causing the problem. Activation imbalance among … Tennis elbow can severely limit the ways in which a person is able to move their arm. Tennis Elbow: Information on causes, symptoms, diagnosis and treatment (1) - Tennis elbow or lateral epicondylitis is a condition where the outer part of the elbow becomes painful and tender, usually as a result of repeated strain, overuse, or trauma to the region. D.R. Br J Sports Med. [email protected] or [email protected] Introduction Traditional Chinese acupuncture has been shown to be an effective therapy for reducing pain and improving function in an arm afflicted with common conditions such as tennis elbow (Ellis 2004). To the sideline observer, however, single-event trauma is the most visible cause of injury. I remember thinking early on in my career "I hope this tennis elbow patient doesn't ask me too many more questions, because I'm either going to have to make something up, or quickly disappear to look up some info". Prior reading: Prior to commencing this module it is suggested that you: • Revise anatomy of the shoulder complex and elbow joint • Clarkson, HM. 142Goran Radunovic et al Ultrasound assessment of the elbow quadrant approach [1 3,5], represented by anterior, later-al, medial and posterior aspects of the elbow joint [1,5,6]. An assessment of a patient presenting with lateral elbow pain should include grip strength using a hand-held dynamometer – up to a loading where pain presents (1). Occupational health specialists Leigh Turvey and Anne Harriss examine a case study involving the injury and its impact on work. The test is positive if symptoms are reproduced. Lateral epicondylitis, or tennis elbow, is a degenerative condition that involves the origin of the common extensor tendons as it attaches to the lateral epicondyle of the humerus, causing pain and functional impairment (Chiang, Hsieh and Lew, 2011). Tennis elbow or, to give it its correct term, lateral epicondylitis (LE) is characterised by pain over the lateral epicondyle of the humerus. Lateral epicondylitis, commonly known as “tennis elbow”, is the most common cause of discomfort or disability of elbow .Lateral epicondylitis, caused by repeated contraction of the forearm extensor muscles, progressively results in micro-tearing with subsequent degeneration, immature repair, and tendinosis, particularly at initial part of the common extensor tendon (CET) , . 2:4. . Resisted wrist extension. To quickly screen for lateral epicondylitis you can ask the patient to perform active wrist extension against resistance. Straightenthen your wrist. This allows repeated measurements in comparison to the non-involved arm. Tennis elbow test. This may be due to disuse and deconditioning syndrome caused by fear avoidance, and needs to be addressed in prevention and treatment. Resisted extension of just the middle finger. Learn more about the causes, risk factors, symptoms, diagnosis, and treatment for tennis elbow. Wrist flex Keeping your arm straight in front with your palm facing down, gently bend your wrist down. Affiliations. Lateral epicondylitis (a.k.a. Pain over the lateral epicondyle of the humerus during loading of the wrist extensor muscles is a common musculoskeletal presentation in men and women between 35 and 54 years of age. Resisted middle finger extension. Pacific Medical Imaging & Oncology Center, Alhambra, CA Valley Imaging Partnership, – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 40e6ff-NjM5N minor unrecognised trauma occurring during the swinging of a tennis racket). Tennis elbow is the common term for the pain that happens when the tendons on the outer side of your elbow are overworked due to repeated use. Chapter Swinson. This involves attempting to extend the wrist (move upwards, palm down) against resistance. o. Ligamentous stability (elbow. Elbow complaints are often related to pain, such as epicondylitis (tennis and golfer’s elbow), fractures, and bursitis. Although the pathology is in the elbow region, patients present with gradual onset of pain on extension movements of the wrist and fingers and supination of the forearm. Occasionally elbow … Department of Physical Medicine and Rheumatology, King's College Hospital, London SE5 9RS, United Kingdon. Tennis elbow This leaflet provides general information about tennis elbow and simple exercises that may help. • Hoppenfeld, S. (1976). MRI EVALUATION OF TENNIS INJURIES TENNIS ELBOW AND BEYOND Peter P. Chow, M.D., M.P.H. It's also common known as "lateral epicondylitis" and it's mainly caused by inflammation of the foreman muscle that is it attached to the elbow. Soft tissue assessment is key if surgery (particularly elbow replacement) is considered. Richards. Sports Med Arthrosc Rehabil Ther Technol. Chapter 3 and 4. Department of Physical Medicine and Rheumatology, King's College Hospital, London SE5 9RS, United Kingdon. Physiotherapy is often a treatment of choice, but previous reviews have failed to draw any conclusions as to which is the most effective therapeutic modality in the management of this condition. Th e elbow fl exors are the biceps brachii, brachialis, and brachioradialis muscles ( Fguri e 21-4 ). Key messages of this review. A number of simple treatments can help alleviate the pain of tennis elbow. A global upper limb weakness exists in tennis elbow. Petrella RJ, Cogliano A, Decaria J, Mohamed N, Lee R. Management of Tennis Elbow with sodium hyaluronate periarticular injections. . Direct trauma to the elbow, such as colliding with another player or falling onto the elbow. Zeisig E, Fahlström M, Ohberg L, Alfredson H. Pain relief after intratendinous injections in patients with tennis elbow: results of a randomised study. AnthonyJ. 42(4):267-71. . #### Summary points Tennis elbow is a tendinopathy of the common extensor origin (fig 1⇓) of the lateral elbow. Golfer’s Elbow affects the other side of the elbow joint and is a mirror condition of Tennis Elbow with treatment being essentially the same. Because the elbow is quite stable, direct trauma to the elbow is usually necessary to cause fracture or dislocation. (Tennis Elbow / Golfer’s Elbow) Purpose of Program _____ Specific exercises to stretch and strengthen the muscles attached to the injured tendon will help with the healing process. However, it can often last for several weeks or months, because tendons heal slowly. Lateral elbow tendinopathy affects approximately 1% … Playing tennis or other racket sports in inclement weather, including hitting rain-soaked tennis balls and/or playing into the wind.. Elbow injuries are common and acute elbow trauma accounts for 2-3% of all visits to the emergency department. 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