Tennis elbow
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Transcript of Tennis elbow
TENNIS ELBOW
TENNIS ELBOW
TENNIS ELBOW SYNDROME ENCOMPASSES LATERAL , MEDIAL AND POSTERIOR ELBOW SYMPTOMS.
COMMONLY ENCOUNTERED IS LATERAL TENNIS ELBOW-KNOWN AS CLASSICAL TENNIS ELBOW
IT IS THE PAIN AND TENDERNESS ON THE LATERAL SIDE OF THE ELBOW SOME ARE WELL DEFINED AND SOME VAGUE,THAT RESULTS FROM REPETITIVE SRESS
OTHER VERIETIES
MEDIAL TENNIS ELBOW (GOLFERS ELBOW)
INFLAMMATION AT THE ORIGIN OF FLEXOR TENDONS AT THE MEDIAL EPICONDYLE OF THE HUMERUS
POSTERIOR TENNIS ELBOW-AROUND THE MARGINS OF OLECRANON PROCESS
LOCATION OF PAIN IN T.ELBOW LATERAL EPICONDYLE (75%) LATERAL MUSCLE MASS (17%) MEDIAL EPICONDYLE (10%) POSTERIOR (8%)
LATERAL TENNIS ELBOW
IT IS THE LESION AFFECTING THE TENDINOUS ORIGIN OF COMMON WRIST EXTENSORS
MEN>WOMEN BELIEVED TO BE A DEGENERATIVE
DISORDER
CAUSES
EPICONDYLITIS-DUE TO SINGLE OR MULTIPLE TEARS IN THE COMMON EXTENSOR ORIGIN,PERIOSTITIS,ANGIOFIBROBLASTICPROLIFERATION OF ECRB etc
INFLAMMATION OF ADVENTITIOUS BURSA-BETWEEN COMMON EXTENSOR ORIGIN AND RADIOHUMERAL JOINT.
CALCIFIED DEPOSITES WITH IN THE COMMON EXTENSOR TENDON
CAUSES
PAINFUL ANNULAR LIGAMENT-DUE TO HYPERTROPHY OF SYNOVIAL FRINGE BETWEEN RADIAL HEAD AND CAPITULUM
PAIN OF NUEROLOGICAL ORIGIN-CS AFFECTION,RADIAL NERVE ENTRAPMENT etc
ECRB IS THE MOST COMMON INVOLVED STRUCTURE IN L.E
MORE COMMON IN THE DOMINATED ARM
SEEN IN
ALL LEVELS OF TENNIS PLAYERS(UP TO 50% AT SOME TIME IN CAREER).
IT IS MORE COMMON IN NON TENNIS PLAYERS(95%).
SEEN IN OTHER SPORTS ALSO (THROWING SPORTS , SWIMMING)
OCCUPATIONAL-CARPENTARY , PLUMPING , TEXTILE WORKERS
HOUSE WIVES(SQUEEZING CLOTHES)
PATHOPHYSIOLOGY AND RELATED SYMPTOMS STAGE I : ACUTE INFLAMMATION BUT
NO ANGIOBLASTIC INVASION(PT C/O PAIN DURING ACTIVITY)
STAGE II:C/C INFLAMMATION+SOME ANGIOBLASTIC INVASION(PAIN BOTH DURING ACTIVITY AND REST)
STAGE III:C/C INFLAMMATION WITH EXTENSIVE ANGIOBLASTIC INVASION(REST PAIN,NIGHT PAINS ,PAIN DURING DAILY ACTIVITIES)
CLINICAL TESTS
LOCAL TENDERNESS ON THE OUTSIDE OF THE ELBOW AT THE C.E.O WITH ACHING PAIN IN THE BACK OF FOREARM
COZENS TEST:PAINFUL RESTRICTED EXTENSION OF WRIST WITH ELBOW IN FULL EXTENSION ELICITS PAIN AT THE LATERAL ELBOW.
ELBOW HELD IN EXTENSION,PASSIVE WRIST FLEXION AND PRONATION PRODUCES PAIN.
MAUDSLEYS TEST:RESTRICTED EXTENSION OF MIDDLE FINGER ELICITS PAIN AT THE LATERAL EPICONDYLE DUE TO DISEASE IN THE EXTENSOR DIGITORUM COMMUNIS
RADIOGRAPHY
AP , LATERAL , RADIOCAPITELLAR VIEWS
16% CASES FAINT CALCIFICATION ALONG L.E
TREATMENT
CONSERVATIVE MANAGEMENTREST AND PHYSIOTHERAPY (50-75%) CHANGING TENNIS STROKES (92%) STREATCHING EXERCISES (84%) USE OF SPLINTS (83%) NSAIDS (85%) INJECTION OF LOCAL ANAESTHETIC AND
STEROID BOTULINUM TOXIN TYPE A TO PARALYZE THE
COMMON EXTENSOR ORIGIN THAT HAS NOT IMPROVED WITH CONSERVATIVE MEASURES
MILLS MANOEUVRE10% OF CASES DO NOT RESPOND TO
CONSERVATIVE MANAGEMENTA FORCEFUL EXTENSION OF A FULLY
FLEXEDAND PRONATED FOREARM AFTER
INJECTION
SURGICAL METHODS
PERCUTANEOUS RELEASE OF EPICONDYLAR MUSCLES
BOSWORTHTECHNIQUE OF EXICION OF PROXIMAL PORTION OF ANNULAR LIGAMENT,RELEASE OF THE ORIGIN OF EXTENSOR MUSCLES,EXCISION OF THE BURSA AND EXCISION OF SYNOVIAL FRINGES.
NEW TREATMENT MODALITIES
USE OF EXTRACORPOREAL SHOCK WAVE THERAPY(ESWT)
CASES OF FAILED CONSERVATIVE TREATMENT FOR ATLEAST 6 MONTHS
2000 SHOCK WAVES THREE TIMES AT MONTHLY INTERVALS FOR 6 MONTHS
ARTHROSCOPIC RELEASE:OF ECRB WITH FAILED CONSERVATIVE TREATMENT FOR 6 MONTHS.MINIMALLY INVASIVE AND HELPS IN EARLY REHABILITATION.
NEW TREATMENT MODALITIES
AUTOLOGUS BLOOD INJECTIONS:IN REFRACTORY CASES,INJECTION OF 2 ML OF AUTOLOGUS BLOOD AND 0.5% BUPIVICAINE HAS BEEN TRIED
COUNTERFORCE BRACING(TENNIS ELBOW OR FOREARM BAND):THESE FORCES RELEASE THE FORCES IN THE ECRB REGION
REHABILITATIVE EXERCICES:WRIST FLEXION , EXTENSION,FOREARM SUPINATION AND PRONATION,WRIST RADIAL AND ULNAR DEVIATIONS AT 3 SETS OF 10 REPETITIONS EVERYDAY FOR 3 TO 6 MONTHS(KNOWN TO GIVE GOOD RESULTS)
NEW TREATMENT MODALITIES
USG GUIDED PERCUTANEOUS NEEDLE THERAPY:USG GUIDED CORTICOSTEROID INJECTION AND NEEDLE DEBRIDEMENT OF THE STRUCTURES AROUND LATERAL EPICONDYLE.
INDICATION:SMALL TEARS,NOT RESPONDING TO CONSERVATIVE THERAPY AND IF TOO SMALL FOR SURGERY
ADVANTAGES :MINIMALLY INVASIVE PROCEDURE RESTORATION OF FUNCTION IS
RAPID THE OPTION OF SURGERY IS STILL
OPENIN EXPERT HANDS IT HAS SUCCESS RATE OF 65%
PROGNOSIS
RESPONSE TO INITIAL THERAPY IS COMMON,BUT SO ARE RELAPSE(18-50%)AND /OR PROLONGED,MODERATE DISCOMFORT(40%)
THANK YOU