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Tennis elbow
1.
2. TENNIS ELBOW
TENNIS ELBOW SYNDROME
ENCOMPASSES LATERAL , MEDIALAND
POSTERIOR ELBOW SYMPTOMS.
COMMONLY ENCOUNTERED IS LATERAL
TENNIS ELBOW-KNOWN AS CLASSICAL
TENNIS ELBOW
IT ISTHE PAIN ANDTENDERNESSONTHE
LATERAL SIDE OFTHE ELBOW SOMEARE
WELL DEFINED AND SOMEVAGUE,THAT
RESULTS FROM REPETITIVE SRESS
3. OTHER VERIETIES
MEDIALTENNIS ELBOW (GOLFERS ELBOW)
INFLAMMATION ATTHE ORIGIN OF
FLEXORTENDONSATTHE MEDIAL
EPICONDYLE OFTHE HUMERUS
POSTERIOR TENNIS ELBOW-AROUNDTHE
MARGINS OF OLECRANON PROCESS
4. LOCATION OF PAIN IN T.ELBOW
LATERAL EPICONDYLE (75%)
LATERAL MUSCLE MASS (17%)
MEDIAL EPICONDYLE (10%)
POSTERIOR (8%)
5. LATERAL TENNIS ELBOW
IT ISTHE LESION AFFECTINGTHE
TENDINOUS ORIGIN OF COMMONWRIST
EXTENSORS
MEN>WOMEN
BELIEVEDTO BE A DEGENERATIVE
DISORDER
6.
7. CAUSES
EPICONDYLITIS-DUETO SINGLE OR
MULTIPLETEARS INTHE COMMON
EXTENSOR
ORIGIN,PERIOSTITIS,ANGIOFIBROBLASTIC
PROLIFERATIONOF ECRB etc
INFLAMMATION OF ADVENTITIOUS
BURSA-BETWEEN COMMON EXTENSOR
ORIGIN AND RADIOHUMERAL JOINT.
CALCIFIED DEPOSITESWITH INTHE
COMMON EXTENSORTENDON
9. ECRB ISTHE MOST COMMON INVOLVED
STRUCTURE IN L.E
MORE COMMON INTHE DOMINATEDARM
10.
11. SEEN IN
ALL LEVELS OFTENNIS PLAYERS(UPTO
50% AT SOMETIME IN CAREER).
IT IS MORE COMMON IN NONTENNIS
PLAYERS(95%).
SEEN IN OTHER SPORTSALSO (THROWING
SPORTS , SWIMMING)
OCCUPATIONAL-CARPENTARY , PLUMPING
,TEXTILEWORKERS
HOUSEWIVES(SQUEEZING CLOTHES)
12. 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
DURINGACTIVITY AND REST)
STAGE III:C/C INFLAMMATIONWITH
EXTENSIVE ANGIOBLASTIC INVASION(REST
PAIN,NIGHT PAINS ,PAIN DURING DAILY
ACTIVITIES)
13. CLINICAL TESTS
LOCALTENDERNESS ONTHE OUTSIDE OFTHE
ELBOWATTHE C.E.OWITH ACHING PAIN INTHE
BACK OF FOREARM
COZENSTEST:PAINFUL RESTRICTED EXTENSION
OFWRISTWITH ELBOW IN FULL EXTENSION
ELICITS PAIN ATTHE LATERAL ELBOW.
ELBOW HELD IN EXTENSION,PASSIVEWRIST
FLEXIONAND PRONATION PRODUCES PAIN.
MAUDSLEYSTEST:RESTRICTED EXTENSION OF
MIDDLE FINGER ELICITS PAIN ATTHE LATERAL
EPICONDYLE DUETO DISEASE INTHE EXTENSOR
DIGITORUM COMMUNIS
14. RADIOGRAPHY
AP , LATERAL , RADIOCAPITELLARVIEWS
16% CASES FAINT CALCIFICATION ALONG
L.E
15. TREATMENT
CONSERVATIVE MANAGEMENT
REST AND PHYSIOTHERAPY (50-75%)
CHANGINGTENNIS STROKES (92%)
STREATCHING EXERCISES (84%)
USE OF SPLINTS (83%)
NSAIDS (85%)
INJECTION OF LOCAL ANAESTHETIC AND
STEROID
BOTULINUM TOXIN TYPE ATO PARALYZETHE
COMMON EXTENSOR ORIGINTHAT HAS NOT
IMPROVED WITH CONSERVATIVE MEASURES
16. MILLS MANOEUVRE
10% OF CASES DO NOT RESPONDTO
CONSERVATIVE MANAGEMENT
A FORCEFUL EXTENSION OF A FULLY FLEXED
AND PRONATED FOREARMAFTER INJECTION
17. SURGICAL METHODS
PERCUTANEOUS RELEASE OF
EPICONDYLAR MUSCLES
BOSWORTHTECHNIQUEOF EXICION OF
PROXIMAL PORTION OF ANNULAR
LIGAMENT,RELEASE OFTHE ORIGIN OF
EXTENSOR MUSCLES,EXCISIONOFTHE
BURSAAND EXCISION OF SYNOVIAL
FRINGES.
18. NEW TREATMENT MODALITIES
USE OF EXTRACORPOREAL SHOCKWAVE
THERAPY(ESWT)
CASES OF FAILED CONSERVATIVE
TREATMENT FOR ATLEAST 6 MONTHS
2000 SHOCKWAVESTHREETIMES AT
MONTHLY INTERVALS FOR 6 MONTHS
ARTHROSCOPIC RELEASE:OF ECRBWITH
FAILED CONSERVATIVETREATMENT FOR 6
MONTHS.MINIMALLY INVASIVE AND HELPS
IN EARLY REHABILITATION.
19. NEW TREATMENT MODALITIES
AUTOLOGUS BLOOD INJECTIONS:IN
REFRACTORY CASES,INJECTION OF 2 ML OF
AUTOLOGUS BLOODAND 0.5% BUPIVICAINE HAS
BEENTRIED
COUNTERFORCE BRACING(TENNIS ELBOW OR
FOREARM BAND):THESE FORCES RELEASETHE
FORCES INTHE ECRB REGION
REHABILITATIVE EXERCICES:WRIST FLEXION ,
EXTENSION,FOREARM SUPINATION AND
PRONATION,WRIST RADIAL AND ULNAR
DEVIATIONS AT 3 SETS OF 10 REPETITIONS
EVERYDAY FOR 3TO 6 MONTHS(KNOWNTO GIVE
GOOD RESULTS)
20. NEW TREATMENT MODALITIES
USG GUIDED PERCUTANEOUS NEEDLE
THERAPY:USG GUIDED CORTICOSTEROID
INJECTION AND NEEDLE DEBRIDEMENT OFTHE
STRUCTURES AROUND LATERAL EPICONDYLE.
INDICATION:SMALLTEARS,NOT RESPONDINGTO
CONSERVATIVETHERAPY AND IFTOO SMALL FOR
SURGERY
ADVANTAGES :MINIMALLY INVASIVE PROCEDURE
RESTORATION OF FUNCTION IS RAPID
THE OPTION OF SURGERY IS STILL OPEN
IN EXPERT HANDS IT HAS SUCCESS RATE OF 65%