Tennis elbow
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Transcript of Tennis elbow
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TENNIS ELBOW
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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
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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
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LOCATION OF PAIN IN T.ELBOW LATERAL EPICONDYLE (75%) LATERAL MUSCLE MASS (17%) MEDIAL EPICONDYLE (10%) POSTERIOR (8%)
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LATERAL TENNIS ELBOW
IT IS THE LESION AFFECTING THE TENDINOUS ORIGIN OF COMMON WRIST EXTENSORS
MEN>WOMEN BELIEVED TO BE A DEGENERATIVE
DISORDER
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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
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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
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ECRB IS THE MOST COMMON INVOLVED STRUCTURE IN L.E
MORE COMMON IN THE DOMINATED ARM
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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)
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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)
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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
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RADIOGRAPHY
AP , LATERAL , RADIOCAPITELLAR VIEWS
16% CASES FAINT CALCIFICATION ALONG L.E
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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
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MILLS MANOEUVRE10% OF CASES DO NOT RESPOND TO
CONSERVATIVE MANAGEMENTA FORCEFUL EXTENSION OF A FULLY
FLEXEDAND PRONATED FOREARM AFTER
INJECTION
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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.
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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.
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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)
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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%
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PROGNOSIS
RESPONSE TO INITIAL THERAPY IS COMMON,BUT SO ARE RELAPSE(18-50%)AND /OR PROLONGED,MODERATE DISCOMFORT(40%)
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THANK YOU