- The document presents a case study of lateral epicondylitis (tennis elbow) in a 30-year-old female patient. - Objective assessment found tenderness and swelling over the lateral epicondyle of the right elbow, with reduced range of motion. Cozen's and Mill's tests were positive. - X-rays were normal. The patient was diagnosed with lateral epicondylitis and a treatment plan included modalities for pain relief, exercises to increase strength and flexibility once pain subsided, and advice to rest the elbow and avoid aggravating activities.

1. A Case Presentation On Lateral
Epicondylitis.
PRESENTED BY – PRASANJIT SHOM
BPT 4TH YEAR.

2. INTRODUCTION
Lateral Epicondylitis also known as Tennis elbow, is a condition in which
the outer part of the elbow becomes painful and tender. The pain may also
extend into the back of the forearm and grip strength may be weak. It is
due to excessive use of the muscles of the back of the forearm.

3. ANATOMY
 THE ELBOW JOINT IS MADE UP OF THREE BONES: THE HUMERUS (UPPER ARM
BONE), THE RADIUS AND ULNA (TWO BONES IN THE FOREARM). AT THE DISTAL
END OF THE HUMERUS THERE ARE TWO EPICONDYLES, ONE LATERAL (ON THE
OUTSIDE) AND ONE MEDIAL (ON THE INSIDE).

4. Anatomy
 Common Extensors:
 Extensor Carpi Radialis Brevis
 Extensor Carpi Radialis Longus
 Extensor Digitorum
 Extensor Carpi Ulnaris

5. ANATOMY
 Common Ligaments:
 Radial collateral Ligament
 Lateral ulnar collateral ligament
 Annular Ligament

6. CAUSES
 LATERAL EPICONDYLITIS IS AN OVER USE AND MUSCLE STRAIN INJURY. The cause is
repeated contraction of the forearm muscles that you use to straighten and raise your
hand and wrist.
 Other Causes:
• Playing Tennis
• Using plumbing tools
• Painting
• Cutting up coocking ingredients
• Repetitive computer mouse use
• Wring out the cloths etc.

7. A 1. DEMOGRAPHIC DATA
 NAME :- SHIPRA SAHA
 AGE:- 30 YEARS
 GENDER:- FEMALE
 OCCUPATION:- HOUSEWIFE
 ADDRESS:- UDAIPUR, GOMATI TRIPURA.
 HAND DOMINANCE:- RIGHT HAND

8. 2. SUBJECTIVE ASSESSMENT
 PATIENT CHIEF COMPLAINT:- PATIENT COMPLAINING THAT SHE HAVE
PAIN HER RIGHT ELBOW WHILE DOING ANY WORK BY HAND.
 HISTORY OF PRESENT ILLNESS:- SHE STARTED GETTING HER PAIN IN
HER RIGHT ELBOW ABOUT 2 MONTHS PREVIOUSLY. THE PAIN WAS
INITIALLY A MILD ACHING IN HER RIGHT ELBOW WHILE DOING DAILY
ACTIVITY FOR LAST TWO MONTHS. BUT FROM LAST 3 DAYS PAIN GOT
SUDDENLY MUCH WORSEN AFTER LAPPING WALLS OF HER HOUSE
WITH MUD.

9. MEDICAL HISTORY
 DIABETES MALLITUS:- NO
 HYPERTENTION:- NO
 URIC ACID:- NO
 THYROIDISM:- NO
 RA FACTOR:- NO

10. PAIN HISTORY
 ONSET:- GRADUAL
 DURATION:- 2 MONTHS( SUB-ACUTE)
 LOCATION:- LATERAL EPICONDYLE OF RT ELBOW.
 RADIATION:- ABSENT
 BEHAVIOR OF PAIN:- PERIODIC PAIN
 QUALITY OF PAIN:- DEEP AND DULL
 AGGRAVATING FACTOR:- PAIN WHILE LIFTING OBJECT AND GRIPING.
 RELIEVING FACTOR:- REST.

11. CONTD…
 SEVERITY OF PAIN:-MODERATE
 VAS SCALE:- IN VAS SCALE SCORE IS 7(MODERATE PAIN)

12. OTHER HISTORY:-
 SURGICAL HISTORY:- NONE
 PERSONAL HISTORY:- NONE
 MARITAL HISTORY:- MARRIED
 FAMILY HISTORY:- NONE
 SOCIOECONOMICAL HISTORY:- MIDDLE CLASS.
 ENVIRONMENTAL HISTORY:- RURAL AREA

13. B 1.OBJECTIVE ASSESSMENT
ON OBSERVATION
 BODY BUILT:- MESOMOROHIC
 DEFORMITY:- NONE
 GAIT:- NORMAL
 POSTURE:- GOOD
 EXTERNAL APPLIANCES:- NONE

14. CONTD…
ON PALPATION :-
 TENDERNESS:- PRESENT (GRADE-II), OVER THE LATERAL EPICONDYLE OF
RIGHT ELBOW.
 OEDEMA:- NO
 SWELLING:- PRESENT OVER THE LATERAL EPICONDYLE OF RT ELBOW.
 TEMPERATURE:- NORMAL

15. ON EXAMINATION
 VITAL SIGNS:-
BLOOD PRESSURE:-130/80 mmHg
PULSE RATE:- 72 BPM
BODY TEMPERATURE:- 98.6°F
RESPIRATORY RATE:- 16 breaths/min

16. ROM OF ELBOW AND WRIST:-
Movement Normal range RIGHT LEFT
1) Elbow flexion 0°-140° 0°-120° 0°-135°
2) Elbow extension 140°-0° 120°-0° 135°-0°
3) Wrist flexion 0°-90° 0°-80° 0°-90°
4) Wrist extension 0°-80° 0-70° 0°-80°

17. SPECIAL TEST 1
 COZEN’S TEST: COZEN’S TEST FOUND POSITIVE.
PROCEDURE: THE PATIENTS ELBOW STABILIZED BY ONE HAND OF THERAPIST AND ASK THE
PATIENT TO MAKE A FIST, PRONATE THE FOREARM AND RADIAALLY DEVIATE AND EXTEND THE
WRIST WHILE THE THERAPIST RESISTS THE MOTION. A POSITIVE SIGN IS INDICATED BY SUDDEN
SEVERE PAIN IN THE LATERAL EPICONDYLE OF HUMERUS.

18. SPECIAL TEST 2
 MILL’S TEST :- MILLS TEST WAS ALSO FOUND POSITIVE.
PROCEDURE: WITH THE ELBOW IN FULL EXTENTION,THE WRIST AND FINGERS
ARE FULLY FLEXED,THEN THE FOREARM IS MAXIMALLY PRONATED. A POSITIVE
SIGN IS INDICATED BY SUDDEN SEVERE PAIN IN THE LATERAL EPICONDYLE OF
HUMERUS.

19. DIFFERNTIAL DIAGNOSIS
 Evaluation should note possible sensory paresthesias in the
superficial radial nerve distribution to rule out Radial tunnel
syndrome.It is the most common cause of refractory lateral pain
and coexists with Lateral Epicondylitis in 10% of the patients.
 The cervical nerve roots should be examined to rule out cervical
radiculopathy.

20. CONTD…
 INVESTIGATIONS: X-RAY, IT DIDN’T SHOWS ANY OBVIOUS PATHOLOGY.
 PROVISIONAL DIAGNOSIS: LATERAL EPICONDYLITIS
 PROBLEM LIST:
1. INCREASED PAIN
2. DECREASED DAILY LIVING ACTIVITIES.
 GOALS:
SHORT TERM: TO DECREASE PAIN, DECREASE SWELLING.
LONG TERM: INCREASE STRENGTH AND FLEXIBILITY.

21. PLAN OF CARE
FOR PAIN RELIEF
 Modalities- Ultrasound, Transcutaneous electrical nerve stimulation (TENS) to
reduce pain and swelling.
 Ice pack or cold pack for reduce inflammation.
 Rigid tapping for proving support to the area.

22. PLAN OF CARE
EXERCISE THERAPY FOR STRENGTHENING AND FLEXIBILITY STARTED AFTER THE
PAIN AND INFLAMMATION REDUCED.
 ISOMATRIC USED FOR GRIP STRENGTH, WRIST EXTENSORS, WRIST FLEXORS,
BICEPS, TRICEPS, AND ROTATOR CUFF.
 STRETCHING EXERCISES FOR INCREASING FLEXIBILITY = REPEAT 10 TIMES
(15-25 SECONDS)
 ACTIVE RESISTED EXERCISE FOR INCREASE STRENGTH AND MUSCLE TONE.

23. EXERCISES FOR TENNIS ELBOW
M

24. HOME ADVICE
 Give rest to your elbow.
 Avoid activities that aggravate your elbow pain.
 Use elbow braces/splint/straps.

25. CONCLUSION:
LATERAL EPICONDYLITIS OR TENNIS ELBOW IS A COMMON DISORDER
AMONGST TENNIS PLAYER BUT ALL INDIVIDUALS EXPOSED TO REPETITIVE
STRES ON THE WRIST EXTENSORS ARE AT RISK FOR DEVELOPING THE
CONDITION. PATIENT SHOULD BENIGN NATURE OF THE CONDITION. INITIAL
TREATMENT SHOULD CONSISTS OF REST AND ERGONOMIC MEASURES TO
DIMINISH THE REPEATITIVE STRESS.

26. THANK YOU