This document contains a medical case report for a 56-year-old female seamstress presenting with a 4-month history of lateral elbow pain aggravated by activities like sewing. On examination, palpation of the lateral epicondyle and common extensor origin was painful, and Cozen's and Mill's tests were positive, consistent with a diagnosis of lateral epicondylitis. The treatment plan involves ultrasound, transverse frictions, range of motion exercises, grip strengthening, and advice to avoid aggravating activities to relieve pain, break adhesions, restore range of motion, and strengthen muscles. Progress will be monitored using pain scales, grip strength tests, and functional assessments.

1. UCP/AL/11/183

2. 1. Name : I.M. Ranjanee
2. Age : 56 years
3. Sex : Female
4. Address : Kelaniya
5. Civil Status : Married
6. No. of children : 4
7. Occupation :seamstress
8. Present complaints: pain over the
lateral aspect of elbow for the
past 4 months

3. 9. Pain :
 Location: lateral aspect of elbow and
radiating down sometimes
 Onset: gradual, no history of trauma
 Type : aching pain
 Aggravating factors: cutting with
scissors, carrying heavy loads, squeezing,washing clothes
 Easing factors: rest
 24 hour behaviour : worse at night, stiffness in hand in
morning
 Worsening/ better/ same ? Worsening
10. Sensation (paresthesia, numbness) : none
11. Past medical history : no HBP , no diabetes

4. Observation
Observed from anterior, posterior,lateral aspects
1. Bony and soft tissue contours: normal
2. Colour of skin: normal
3. Carrying angle : normal (equal in both limbs)
4. Normal functional position could be obtained
(90 flexion, forearm mid position)

5. Palpation :
 Medial and lateral epicondyles and
supracondylar ridges
 Radial head
 Radiohumeral joint line
 Olecranon process
 Common extensor and flexor origins
 Bicipital tendon
Palpation of lateral epicondyle and common
extensor origin elicited pain.

6. Examination:
 AROM : elbow flexion/extension, forearm
supination/pronation, wrist flexion/extension, wrist
ulnar/ radial deviation normal
wrist and MTP flexion and pronation painful
 PROM : normal
end feels normal
 Resisted isometric movements : wrist extension and
flexion painful, MTP extension painful
 Functional assessment : grip strength of affected limb
comparatively lesser than the unaffected limb
standard fist, hook grasp – normal
pulp to pulp thumb to all fingers/ tip to tip thumb
to all fingers - normal

7. Special Tests :
1. Cozen’s test +
2. Mill’s test +

8.  Lateral epicondylitis ( Tennis elbow)
no neurological symptoms ( no cervical
pathology)
bony and soft tissue contours normal/
ROM not restricted( no dislocation or # )

9. o Short term goals - Pain relief
break adhesions
o Long term goals - Restore ROM
Muscle strengthening
Pain relief = Ultrasound : 0.5 Wcm-2 , continuous mode, 1:2 Mark
space ratio for 8 min on alternate days
Break adhesions =Ultrasound
Transverse frictions : 10 minutes per day on
alternate days
Restore ROM = ROM exercises for fingers and wrist : flexion ,
exrension
Muscle strengthening = grip strengthening exercises
Advising patient to avoid movements involving extensive use of
forearm extensors such as cutting, carrying heavy load

10.  Ultrasound : chronic , superficial tissue
local heating helps break adhesions
and reliefs pain
 Transverse frictions : pettrisage , mobilises the tendon ,
breaks adhesions
 ROM exercises : maintains ROM , prevent joint
stiffness
 Muscle strengthening : improve functionality , improve
grip
 advise : to prevent constant micro tears occurring to
the tendon

11.  Pain
Numeric Pain Scale
 Grip strength
dynamometer
 Functional assessment

12. THANK YOU