LATERAL EPICONDYLITIS

1. {
LATERAL EPICONDYLITIS

2.  It is also known as tennis elbow.
 Tennis elbow is a pathological condition of the common extensor
muscles at their origin on the lateral humeral epicondyle .
 Epicondylitis suggest an inflammation at one of the epicondyles of
the elbow.
 Epicondylosis is a chronic overuse injury to the same elbow
structures .
 Both of these conditions result from repeated microtrauma to the
tendon, leading to disruption of the tendon’s internal structure.
DEFINITION

3.  Generally, overload of the muscle tendon unit results in the initial
inflammatory process and continued use results in the tendon
breakdown.
 The actual pathology is called tendinopathy, the collagen become
disorganized with loss of parallel orientation , asymmetrical crimping
and loosening and microtear
 Because of the hypovascularity of tendons, the collagen fibres tend to
breakdown .
PATHOLOGY

4.  The mechanism of injury involve repetitive microtrauma.
 Caused by eccentric and concentric overloading of the
extensor carpi radialis brevis and other wrist extensors .
 Acute trauma to the lateral epicondyle can cause
epicondylitis.
Mechanism Of Injury

5.  Repititive movements
 Forceful movements
 Manual labour
 Age related factors
 Constant keyboard and mouse use
 trauma
RISK FACTORS AND CAUSES

6.  Local tenderness is present directly over the lateral
epicondyle and pain sometimes radiate down the forearm.
 Pain is aggravated by strong gripping or by lifting heavy
objects.
 Pain occurs with passive stretching of the palmar forearm
muscles.
 Radiography reveal tendon calcification in 20% of patients.
 Morning stiffness
 Occasionally night pain
 Dropping of objects/ weak grip strength
 Patient will typically have full ROM
SIGNS AND SYMPTOMS

7. SPECIAL TESTS FOR TENNIS
ELBOW
 COZEN’S TEST- The patient’s elbow is stabilized
by the examiner’s thumb, which rests on the
patient’s lateral epicondyle. The patient is then
asked to make a fist, pronate the forearm and
radially deviate and extend the wrist while
examiner resists the motion. The positive sign is
indicated by sudden severe pain in the area of
lateral epicondyle.

8. MILL’S TEST- While palpating the lateral epicondyle the
examiner pronates the patient’s forearm and flexes the wrist
fully and extends the elbow. The positive test is indicated by
pain over the lateral epicondyle of humerus.

9. MAUDDSLEY’S TEST- The examiner resist extension of the 3rd
digit of the hand, stressing the extensor digitorum muscle and
tendon. A positive test is indicated by pain over the lateral
epicondyle of the humerus.

10. X-rays are not necessary.
Ultrasound or Magnetic Resonance Imaging (MRI) scans may
be used to show changes in the tendon at the site of
attachment onto the bone.
MRI typically shows fluid in the ECRB origin.
INVESTIGATIONS

11. 1.Rest
2.Splinting/Bracing
3.Change of job
4.Heat
5.Steroid injection
6.Taping
7.Cold packs
8.Topical NSAIDS gel
9.Analgesic
10.Massage
11.Endurance training
12.Dry needling
13.Blood injections
NON OPERATIVE OPTIONS

12.  ROM EXERCISES OF ELBOW-
 Elbow flexion and extension exercises.
 Squeeze a sponge ball repetitively for forearm and hand
strength
EXERCISES FOR TENNIS ELBOW

13. Case Study

14. DEMOGRAPHIC DETAILS-
NAME - Dr.Nazmi Khan
AGE - 26
GENDER- Female
ADDRESS- Delhi
OCCUPATION- Physiotherapist
HAND DOMINENCE- Right handed
CHIEF COMPLAINT –Pain in right elbow with lifting weights.
Pain is from 3 months, pain increased from 2 days after doing
planks.

15.  HISTORY-
 Pain in right elbow from 2 days
 PAST HISTORY- Pain in right elbow from 3 months
 MEDICAL HISTORY- HTN not present , diabetes
mellitus not present
 SURGICAL HISTORY- no surgical history
 PAIN ASSESSMENT-
 MODE-Gradual
 SIDE- Right
 NATURE OF PAIN –Dull pain

16.  DURATION-2-3 months
 SITE- Lateral epicondyle
 AGGREVATING FACTORS- Movement(on
doing exercises)
 RELIEVING FACTORS- Rest(sleep)
 TEMPORAL VARIATION- Pain more in
evening
 VAS SCALE- 7/10
 ON OBSERVATION-
 EDEMA- Present over olecranon fossa
 ATTITUDE OF LIMB- Normal
 ON PALPATION-

17.  TENDERNESS- Present over lateral epicondyle
grade 2
 SWELLING- Present over lower part of tricep
muscle
 ON EXAMINATION-
 ELBOW FLEXION- 0-140
 ELBOW EXTENSION- 140-0
 WRIST FLEXION – 0-65
 WRIST EXTENSION- 0-45
 ULNAR DEVIATION- 0-30
 RADIAL DEVIATION-0-20
 MANUAL MUSCLE TESTING-
 WRIST FLEXION- Grade 4

18.  WRIST EXTENSION- Grade 3
 ELBOW FLEXION –Grade 3
 ELBOW EXTENSION – Grade 4
 REFLEXES- Normal
 SENSORY EXAMINATION-
 Sensory loss- no
 Tinel’s sign- Negative
 INVESTIGATIONS-
 No X-RAY
 SPECIAL TESTS-
 COZEN’S TEST- Positive
 MILL’S TEST- Positive
 MAUDSLEY’S TEST- Positive
 DIAGNOSIS- LATERAL EPICONDYLITIS
 SHORT TERM GOALS- To relief pain
 LONG TERM GOALS- To strengthen the muscle