Tennis elbow & Golfer's elbow

Tennis elbow & Golfer's elbow

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  TENNIS ELBOW
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  Tennis elbow isa painful condition affecting the tendinous tissue of the origins of the wrist extensor muscles at the lateral epicondyle of the humerus, leading to loss of function of the affected limb. INTRODUCTION
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  EPIDEMIOLOGY • Most commoncause for elbow symptoms in patients with elbow pain • Affects 1-3% of adults annually • Commonly in dominant arm DEMOGRAPHICS • Up to 50% of all tennis players develop • Risk factors • Poor swing technique • Heavy racket • Incorrect grip size • High string tension • Common in laborers who utilize heavy tools • Workers engaged in repetitive gripping or lifting tasks • Most common between ages of 35 and 50 years old • Men and women equally affected
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  • Tenodesis effectto optimize grip causes overuse of extensor carpi radialis brevis • Precipitated by repetitive wrist extension and forearm pronation • Common in tennis players (backhand implicated) • Pathoanatomy • Usually begins as a microtear of the origin of ECRB • May also involve microtears of ECRL and ECU PATHOPHYSIOLOGY
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  Associated conditions radial tunnelsyndrome is present in 5%
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  SYMPTOMS • pain withresisted wrist extension • pain with gripping activities • decreased grip strength PHYSICAL EXAM PALPATION & INSPECTION Point tenderness at ECRB insertion into lateral epicondyle few mm distal to tip of lateral epicondyle neuromuscular may have decreased grip strength neurological exam helps to differentiate from entrapment syndromes PROVOCATIVE TESTS resisted wrist extension with elbow fully extended resisted extension of the long fingers maximal flexion of the wrist passive wrist flexion in pronation causes pain at the elbow
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  RADIOGRAPHS AP/Lateral of elbow FINDINGS •usually normal • may reveal calcifications in the extensor muscle mass (up to 20% of patients) • may reveal signs of previous surgery MRI • not necessary for diagnosis • increased signal intensity at ECRB tendon origin may be seen (up to 50% of cases) • thickening • edema • tendon degeneration Ultrasonography • requires experienced operator (variable sensitivity/specificity) • most useful diagnostic tool in experienced operator hands • ECRB tendon appears thickened and hypoechoic
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  COZEN'S TEST isa physical examination performed to evaluate for lateral epicondylitis or, tennis elbow. The test is said to be positive if a resisted wrist extension triggers pain to the lateral aspect of the elbow owing to stress placed upon the tendon the extensor carpi radialis brevis muscle. The test is performed with extended elbow. NOTE: With elbow flexed the extensor carpi radialis longus is in a shortened position as its origin is the lateral suracondylar ridge of the humerus. To rule out the ECRB (extensor carpi radialis brevis), repeat the test with the elbow in full extension.
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  MILL’S TEST Technique 1. Patientis seated. 2. The clinician palpates the patient’s lateral epicondyle with one hand, while pronating the patient’s forearm, fully flexing the wrist, the elbow extended. 3. A reproduction of pain in the area of the insertion at the lateral epicondyle indicates a positive test
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  Other Techniques toDiagnose Lateral Epicondylitis Maudsley’s test = Resisted third digit extension Cozen’s test = Resisted wrist extension with radial deviation and full pronation Chair lift test = Lifting the back of a chair with a three finger pinch (thumb, index long fingers) and the elbow fully extended
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  • Nonoperative activity modification,ice, NSAIDS, physical therapy, ultrasound tennis modifications (slower playing surface, more flexible racquet, lower string tension, larger grip) counter-force brace (strap) steroid injections (up to three) physical therapy regimen acupuncture iontophoresis/phonophoresis extracoproeal shock wave therapy outcomes TREATMENT Up to 95% success rate with nonoperative treatment, but patience is required
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  OPERATIVE release and debridementof ECRB origin INDICATIONS if prolonged nonoperative (6-12 months) fails clear diagnosis (isolated lateral epicondylitis) intra-articular pathology CONTRAINDICATIONS inadequate trial of nonsurgical treatment patient noncompliance with the recommended nonsurgical treatment
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  Tennis Elbow, ExtensorCarpi Radialis Brevis https://www.youtube.com/watch?v=GFjOWh4p0lw https://www.youtube.com/watch?v=uSHNPJQEs4Q https://www.orthobullets.com/shoulder-and- elbow/3082/lateral-epicondylitis-tennis-elbow
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  Golfer's elbow, ormedial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle. Pitcher's elbow due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are climber's elbow and little league elbow: all of the flexors of the fingers and the pronators of the forearm insert at the medial epicondyle of the humerus to include: pronator teres, flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, and palmaris longus