Tennis Elbow Ppds
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Transcript of 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
Extension F/F (0-700
) 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
Extension F/F (0-900) 5/5
Abduction F/F (0-500) 5/5
Adduction F/F (500-0) 5/5
Opposition 5-/5
Hi ROM MMT
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Hip ROM MMT
Flexion F/F (0-1250) 5/5
Extension F/F (0-300
) 5/5Abduction F/F (0-450) 5/5
Adduction F/F (0-200) 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
Extension F/F (1350-0) 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
Extension F/F (0-800) 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
Extension F/F (0-800) 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 )