Tennis elbow

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Tennis elbow

  1. 1. 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
  2. 2. OTHER VERIETIES  MEDIALTENNIS ELBOW (GOLFERS ELBOW) INFLAMMATION ATTHE ORIGIN OF FLEXORTENDONSATTHE MEDIAL EPICONDYLE OFTHE HUMERUS  POSTERIOR TENNIS ELBOW-AROUNDTHE MARGINS OF OLECRANON PROCESS
  3. 3. LOCATION OF PAIN IN T.ELBOW  LATERAL EPICONDYLE (75%)  LATERAL MUSCLE MASS (17%)  MEDIAL EPICONDYLE (10%)  POSTERIOR (8%)
  4. 4. LATERAL TENNIS ELBOW  IT ISTHE LESION AFFECTINGTHE TENDINOUS ORIGIN OF COMMONWRIST EXTENSORS  MEN>WOMEN  BELIEVEDTO BE A DEGENERATIVE DISORDER
  5. 5. 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
  6. 6. CAUSES  PAINFUL ANNULAR LIGAMENT-DUETO HYPERTROPHYOF SYNOVIAL FRINGE BETWEEN RADIAL HEADAND CAPITULUM  PAIN OF NUEROLOGICAL ORIGIN-CS AFFECTION,RADIAL NERVE ENTRAPMENT etc
  7. 7.  ECRB ISTHE MOST COMMON INVOLVED STRUCTURE IN L.E  MORE COMMON INTHE DOMINATEDARM
  8. 8. 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)
  9. 9. 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)
  10. 10. 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
  11. 11. RADIOGRAPHY  AP , LATERAL , RADIOCAPITELLARVIEWS  16% CASES FAINT CALCIFICATION ALONG L.E
  12. 12. 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
  13. 13.  MILLS MANOEUVRE 10% OF CASES DO NOT RESPONDTO CONSERVATIVE MANAGEMENT A FORCEFUL EXTENSION OF A FULLY FLEXED AND PRONATED FOREARMAFTER INJECTION
  14. 14. 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.
  15. 15. 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.
  16. 16. 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)
  17. 17. 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%
  18. 18. PROGNOSIS  RESPONSETO INITIALTHERAPY IS COMMON,BUT SOARE RELAPSE(18- 50%)AND /OR PROLONGED,MODERATE DISCOMFORT(40%)

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