Clinical management and rehabilitation of Epicondylitis

8/7/2019 Clinical management and rehabilitation of Epicondylitis

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Gunawan K PM&R


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` Epico ndyl itis-de scrib e inflamma tion , pa in or tende r ne ss in the r eg ion of med ial or la te r ale pico ndyle.

` Med ial e pico ndyl itis-flexor mu sc le g roup.g olferselbo w


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` T he le sio n is f ound prima rily in the ex ten sor ca rpir ad ial is br ev is (EC RB) origin, w ith less f r equen t involvemen t of the ex ten sor ca rpi r ad ial is longu s

(EC RL) and the an te rior portio n of the ex ten sor digitor um co mmun is .` Nirsch l ma inta ins tha t ang iof ibrob lastic

hype rplasia, r e s ulting f rom ava sc ula r co mpro mise

and s ubs equen t micro tea rs in the origin of theEC RB, is the ba sic cau s e of chro nic la te r ale pico ndyl osis


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` Re cen t st ud ie s of chro nic tenn is elbo w have n ot f ound any sign if ican t ev iden ce of inflamma tor yproc e ss e s and the te r m e pico ndyl osis h a s been

s ugge st ed a s a m or e a ppropri a te te r m thane pico ndyl itis .


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` Pa in in d istal to la t e pico ndyle (la t e pico ndyl itis),med e pico ndyle (med e pico ndyl itis)

` Pa in may r ad ia te pro x or distal.` Pa in w ith movemen t of the w rist/h and;g ripping a

door knob or ca rr ying hand ca s e` Re port s well ing.


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` Tende r ne ss ove r ex t mu sc le origin or flexor .` In la t e pico ndyl itis;` pa in is incr ea s ed w ith r e sist ed w rist ex t ,with

elbo w ex tended and f or ea r m pro na ted,w ristr ad ially dev ia ted,a hand in a f ist .

` Middle f inge r te st in ex t can be u s ed.` Med ial e pico ndyl itis,pa in is incr ea s ed w ith r e sist ed

wrist flexion


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` Co mplain of ina bility to lif t or ca rr y obj e ct .` T yping ,u s e co mpute r mous e.` Hand sh ak ing.` Ath le tic a ctivity(tenn is ,g olf)


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` Initial tr ea tmen t co nsists of r ela tive r e st ,` av oidan ce of r e pe titive m ovemen t involving w rist .` Ns a id hea t modal itie s or ice f or a cute.


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`

Pe ri-a rticula r HA tr ea tmen t f or tenn is elbo w wa s sign if ican tly be tte r than co ntro l in impro ving pa ina t r e st and af te r max imal g rip te sting.

` HA tr ea tmen t wa s highly s a tis factor y by pa tien ts

and ph ysici an s and r e s ulted in be tte r r e tur n to pa in f r ee sport co mpa r ed to co ntro l.

` Managemen t of Tenn is Elbo w with so dium hyalu rona te pe ria rticula r inje ctio n.`

Pe tr ella e t al. S ports Med icine, A rthroscop y, Re ha bilita tion,T

he r a py &T

e ch nology 2010, 2:4


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` Tenn is elbo w,` modify the ir ba ckhand stro ke ; the f or ea r m is in

midpro na tion and the tr unk is lean ing f or wa r d,` modify the ir equ ipmen t;r edu cing stri ng ten sio n and

enla r ging the handle siz e.` A two handed ba ckhand w ill r el ieve the str e ss


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` Golferselbo w` Modify the ir s wing to av oid ex ce ssi ve f orc e on

wrist flexor mu sc le. F or ea r m band (co un te r f orc ebr a ce) w or n d istal to flexor and ex t mu sc le g roup origin.

` Wrist imm obi lisa tion sp lint e ithe r med or la t e pico ndyl itis s e t in neu tr al or 30 wrist ex t willr el ieve ex t ca rpi r ad br ev mu sc le


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` T he f irst ph a s e` De cr ea sing pa in :ul tr a so und,ele ctric al

stimula tion, pho nophor e sis ,hea t ,ice,ma ss age)` De cr ea sing d isa bility:edu ca tion,de cr ea sing r e pe titive

str e ss and pr e s e r va tion of m otio n` When pa in f r ee, d o a g r adual pro gr am to impro ve

str eng th and endu r an ce of wrist ex r or flexor ,this pro gr am sho uld be m onitor clos ely

`

S ta rt with st a tic exe,advan ce to pro gr e ssi ve r e sisti veexe .` T he r a band ,l ight we ights or s elf manual r e sist an ce

exe can be u s ed


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` S te roid` P ost inj tr ea tmen t sho uld include icing the a r ea5 -

10 m ts ,wea ring w rist sp lint 2-3 day s av oid

axa ce rba ting a ctivitie s .` Boto x into ex t dig co m lll and iv in tr ea ting la t

e pico ndyl itis` Pe ri a rticula r hyalu ronic a cid inj ,pro mising f or

e pico ndyl itis` not r e co mmended f or med e pico ndyl itis,risk of

ulna r ne r ve injur y.


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` Ind ica ted f or s ympto m n ot r e spo nd to co ns e r va tivetr ea tmen t


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` T hank Y ou

Clinical management and rehabilitation of Epicondylitis

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