By -NAVEEN AGGARWAL

CASE STUDY

DEMOGRAPHIC DATA

NAME- AGE/SEX- / OCCUPATION- ADDRESS- MARITAL STATUS-

CHIEF COMPLAINT PAIN AT LATERAL ASPECT OF ELBOW DIFFICULTY IN ADLS,LIKE-WASHING

CLOTHS,UTENSILS & MAKING FOOD ETC. DIFFICULTY IN LIFTING AND CARRYING

WEIGHT IN RIGHT HAND. PAIN RADIATING DISTALLY AT POSTERIOR

ASPECT OF FOREARM.

H/O PAST ILLNESS MEDICAL HISTORY

PATIENT IS HYPERTENSIVE-TAKING AMLOKIND SINCE LAST 3 YEARS.

SURGICAL HISTORY H/O (4 HOLE PLATTING WITH DYNAMIC SCREW)ORIF IS DONE 2 YEARS BACK IN CASE OF FRACTURE OF NECK OF FEMUR.

H/O PRESENT ILLNESS DIABETIC TREATMENT IS ONGOING H/O HYPERTENSION PAIN AT ELBOW RADIATING DOWNWARD

(DISTALLY) VAS-7 |--------------*------|. ONSET OF PAIN –CONTINOUS(MODERATELY) AGGREVATING FACTOR-TWISSTING MOVEMENT

OF FOREARM & WRIST & GRASPING ACTIVITY. eq: making food, washing cloths, carrying weight, etc.

RELIEVING FACTOR-REST

OBSERVATION

MILD SWELLING PRESENT AROUND THE LATERAL ASPECT OF RIGHT ELBOW.

REDNESS PRESENT ON LATERAL ASPECT OF RIGHT ELBOW.

FOREARM SUPPORTED WITH OTHER HAND i.e. right forearm supported with left hand.

EXAMINATION ACTIVE MOVEMENT Elbow flexion is normal Elbow extension is painful at end range. Wrist flexion and ulnar deviation is normal. Wrist extension and radial deviation mildly painful at end range

but range is complete. Forearm pronation is slightly painful supination is normal PASSIVE MOVEMENT-normal at all joint only elbow extension is

painful at end range. RESISTED MOVEMENT elbow extension wrist extension & radial deviation,forearm

pronation is painful. All other movement are normal.

END FEEL-normal at all noted joint except soft end feel on right elbow extension(due to inflamed joint.)

ROM-normal at all movement except painful wrist extension at end range of motion.

TENDERNESS –present at lateral aspect of elbow just below the lateral epicondyle of humerus.

TEMPRATURE-slightly raise in temp at lateral aspect of elbow

SPECIAL TEST

MAUNDSLEY TEST

COZENS TEST

MILLS TEST

PROVISIONAL DIAGNOSISTENNIS ELBOW(LATERAL EPICONDILITIS)

TREATMENT MODALITIES COLDPACK-FOR 10 MINS TWICE DAILY. U.S.-AT 0.7 WATTS PER CM SQUARE AT 50 DUTY CYCLE FOR 6

MINS FOR 10 DAYS(at tender point) TENS - 4 POLE WITH SMALL ELECTRODES( apply one at above

lateral epicondyle, one below and one on dorsal aspect of forearm and one on dorsum aspect of hand , covering all radiated area of pain) for 15 days

TENNIS ELBOW BEND IS PRESCRIBED AND PRECUATION ARE EXPLAINED.

REST THE ELBOW FOREARM AND WRIST FOR 10 DAYS.

PROGNOSIS

15% RELIEVE ON 3RD VISIT. 25% RELIEVE ON 5TH DAY 35% RELIEVE ON 8TH VISIT (FREE MOVEMENTS ARE STARTED) 55% RELIEVE ON 10TH DAY, U.S. IS DISCONTINUE AND VAS IS

DROP DOWN TO 4 ,improvement in ADLs activities. Isometrics are started-10 sec.hold-10 rpm-BD 80% RELIEVE ON 15TH DAY ,TENS IS DISCONTINUE. Allow to do ADLs Resisted exercises with ½ kg weight is started. Follow PRE program.

TENNIS ELBOW EXERCISE GOALS

TENDON HEALING MUSCLE

STRENGHTENING TENDON

STRENGHTENIG