Physiotherapy- Introduction, Demographics, Pathophysiology, Patient History, Assessment, Special tests, Outcome measures, Differential Diagnosis, Management, References

2.  Chronic overuse injury/ Repetitive microtrauma
injury
 Inflammatory and degenerative origin
 Affects common extensor origin at the elbow
 Deep and Anterior fibres of Extensor Carpi Radialis
Brevis

5.  Tendon cellular and matrix changes
 Alterations in nociceptive processing
 Impairments in sensory and motor function
 Most site of focal degeneration- deep and
anterior fibres of ECRB
 ECRB merges with lateral collateral ligament
and annular ligament of proximal radioulnar
joint

6.  Occupation
 Hand dominance
 Daily behaviors and habits
 Date of prior episodes
 Number of recurrences
 Inducing and aggravating factors
 Treatment modalities
 Tobacco use
 Duration of symptoms
 Number of recurrences

7.  Tenderness at the ECRB origin- common
extensor origin
 Elbow, wrist and forearm range of motion
 Accessory motion of radioulnar, radiohumeral
and humeroulnar joints

8.  Cozen’s test (Sensitivity- 84%)
 Mill’s test
 Maudsley’s test (Sensitivity- 88%)
 Chair test
 Posterolateral rotatory drawer test
 Table top relocation test
 Cervical, Thoracic and Radial nerve function
 Grip weakness

9.  Pain free grip test
 Patient rated tennis elbow evaluation
 Patient Specific functional scale

10.  Cervical radiulopathy
 Frozen shoulder
 Radial tunnel syndrome
 Lateral plica syndrome of elbow
 Posterolateral elbow instability
 Inflammatory edema of elbow muscle
 Other causes- low grade infection,
inflammatory diseases- rheumatoid arthritis

11.  Conservation- Pain management
 Orthotic management
 Surgical Management

12.  Controlling elbow pain
 Preserving movement of the affected limb
 Improving grip strength and endurance
 Restoring normal function of the affected
limb
 Preventing further deterioration

13.  Neurogenic- the presence of nerve fibers with
reactivity to neuropeptides, including
substance P (SP) and calcitonin gene-related
peptide (CGRP)

14.  Ultrasound and Magnetic Resonance Imaging

15.  Rest
 Orthotic wrist splint
 Counterforce elbow strap
 Taping

16.  Activity modification
 Physiotherapy
 NSAIDS
 Extra-corporeal shock wave therapy
 Bracing
 Acupuncture
 Biotherapy- Autologous blood injections (ABI)
Platelet rich plasma injections (PRP)

17.  Modification of activity and avoidance of
overwork
 Turning the palm up while lifting and
avoiding palm-down exercises (transfers
force toward medial epicondyle)
 Correct adverse living habits
 Stay away from some inciting activities
 RICE in the initial stages

18.  Stretching and strengthening of affected wrist
extensors
 Eccentric exercises-EE is executed via
stretching the musculotendinous unit with an
applied load
 Counterforce bracing
 Acupuncture
 Dry Needling

19.  Open
 Percutaneous
 Arthroscopic
 Aim- to debride the degenerated portion of
the ECRB with or without repairing the ECRB
tendon

20.  Ma KL, Wang HQ. Management of Lateral
Epicondylitis: A Narrative Literature Review. Pain
Res Manag. 2020 May 5;2020:6965381. doi:
10.1155/2020/6965381. PMID: 32454922;
PMCID: PMC7222600.
 Hubert Lenoir, Management of lateral
epicondylitis, Orthopaedics & Traumatology:
Surgery & Research, Volume 105, Issue 8,
Supplement, 2019
 Nicholas Johns, Vivek Shridhar, Lateral
epicondylitis: Current concepts, Australian Family
Physician (AFP), Volume 49, Issue 11, November
2020