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Similar to Physiotherapy Case presentation - Tennis Elbow | Lateral Epicondylitis | History Taking | SOAP
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Physiotherapy Case presentation - Tennis Elbow | Lateral Epicondylitis | History Taking | SOAP
- 1. Lateral Epicondylitis (Tennis Elbow) Case Presentation
- 2. Case Presentation Prepared By : Dr. Kaiynat Shafique PT
- 3. Case : Lateral Epicondylitis A 37 y old female, school teacher by profession , presented in Physiotherapy opd with the Complain of pain in the lateral side of her right elbow. She was suffering with this pain from almost six months. According to her history , once her elbow was bumped into the wall, The pain was mild at that time but the pain gradually increases with the passage of time.
- 4. Case : Lateral Epicondylitis Personal History Her diet was normal, She had normal sleep wake cycle. There was no history of any allergy. Vitals • BP: 125/80 mmHg • HR: 80 bpm • RR: 22/min • Temp: 98.6 F • Oxygen Saturation: 95%
- 5. Subjective Assessment Pain Onset: Gradual Nature: Aching Frequency: Intermittent Severity: 05/10 (NPRS) Agg. Factor: Rep. activity (writing, paper checking) Rel. Factor: Rest, Pain killers
- 6. Examination Inspection • No visible joint deformity • No localized Swelling • No Erythema • No Muscle Wasting Palpation • Tenderness : lateral aspect of the right elbow • Skin temp was normal • Skin sensations was intact
- 7. Radiographs X-Ray (R- Elbow – AP view) No boney deformity
- 8. Lab report RBC Normal HB Normal HCT Normal MCV Normal MCH Normal MCHC Normal Platelet Count Normal Neutrophils Normal Lymphocytes Slight inc Monocytes Normal Eosinophils Normal
- 9. Evaluation Range of Motion Muscle Grade (0-5) Wrist Extensors (R) 4+/5 (Painful) Wrist Flexors (R) 5/5 Wrist Extensors (L) 5/5 Wrist Flexors (L) 5/5 Manual Muscle Testing Active (R) eff Active (L) Passive (R) eff Passive (L) Normal Elbow Flex. 140 140 145 145 140- 150 Elbow Ext. 0 0 0 0 0 Wrist Flex. 65 75 68 75 70-80 Wrist Ext. 50 70 55 70 60-80
- 10. Specialized Tests 1. Spurling Test –ve 2. Cozen’s Test +ve 3. Mill’s Test +ve 4. Tinel’s sign –ve 5. Varus Stress Test -ve
- 11. Goals Short term goals • Patient education • Pain reduction Long term goals • Inc muscle strength • Improve ADL’s
- 12. Management Electrotherapy • Ultrasound (For 8 mins) (f 1- 3MHz, Int 0.1-3 W/cm2,) • Transcutaneous electrical nerve stimulation (TENS) – Pain relief
- 13. Management • Education - Activities Modification Manual therapy • Maitland - Humeroradial & Radioulnar Mobilization ( A-P, Grade 1,2) • Myofascial Release Techniques • Mulligan - Mobilization with movement
- 14. Management Exercises • Eccentric Ex (3˟ 10) • Forearm extensor’s stretch (3˟ 10) • Resisted Supination and pronation (3˟ 10) • Ball Squeeze (3˟ 10) • Finger Stretch With Rubber Band (3˟ 10)
- 15. Social Links
Editor's Notes
- Case presentation of lateral epicondylitis.
- A 37 y old female, school teacher by profession , presented in Physiotherapy O.P.D with the complain of pain in the lateral side of her right elbow. She was suffering with this pain from almost six months. According to her history , once her elbow was bumped into the wall, The pain was mild at that time but the pain gradually increases with the passage of time. There was no associated past medical and surgical history.
- Her diet was normal, She had normal sleep wake cycle. There was no history of any allergy. Her vitals like temperature, BP, R.R & Pulse rate were in normal range. The Review of systems shows no involvement of any systemic issue with this pain. Her Lying, sitting and standing posture was normal.
- There was deep aching intermittent Pain present at the outer side of right elbow. Onset of pain was gradual. And the severity of pain was 5 out of 10 according to numeric pain rating scale. Aggravating factor was repetitive activities with right arm including writing or paper checking. Relieving factor was rest and pain killers
- There was not any visible Joint deformity, Swelling, Erythema or muscle wasting. On palpating the Skin temp was normal, Skin sensations was intact and there was tenderness on the lateral aspect of the right elbow.
- X ray of Right elbow shows no boney deformity.
- Her blood report was almost normal just a slight increase in Lymphocytes.
- Her range of motion was almost normal but Wrist extension of right side is slight limited . The manual muscle testing of wrist extensors of right side shows grade 4+. The muscle power of Right Wrist Flexors, Left Wrist Flexors and Left Wrist Extensors was 5 out of 5.
- Cozen and Mill’s Test was positive, Spurling test for Rediculopathy was negative , Tinel Sign for Ulnar nerve entrapment was negative, varus stress test for stability of lateral collateral ligament of elbow was negative
- The short term goals was, Patient education about activity modification to prevent further damage, pain reduction and to gain the patient’s confidence level. The long term goals was to increase the muscle strength and to improve the patient’s activities of daily life.
- Electrotherapeutic modalities including Ultrasound and Transcutaneous electrical nerve stimulations was used.
- Manual Therapy techniques including Humeroradial and Radioulnar Mobilizations, Myofascial Release Techniques, and Mulligan - Mobilization with movement was performed
- Following exercises was advised, Elbow Eccentric Exercises, Forearm extensor’s stretch, Resisted Supination and pronation, Ball Squeeze, and Finger Stretch With Rubber Band