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Tennis Elbow - Vertika Mishra

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18 views

Tennis Elbow - Vertika Mishra

Uploaded by

vertikagolu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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BY:

CASE PRESENTATION

BY:
Vertika Mishra
19/FAS/BPT/035
ASSESSMENT FORM
Demographic details
• Name: xyz
• Occupation: Gym Trainer
• Date of examination: 03/06/24
• Age/gender: 40/M
• Address: Faridabad
• Phone no.: Xxxxxxxxxx
• Referred by: Self
Chief Complaint:
Pain on the lateral side of the elbow for the last 25 days.
History of Present Illness:
The patient reports a gradual onset of pain on the lateral side of his elbow, which has persisted for
approximately 25 days. He denies any specific incident or injury that initiated the pain. The pain is described
as a constant, dull ache that intensifies during wrist extension or when lifting objects.
Medical and Surgical History:
No previous medical or surgical history.
Past History:
As a gym trainer, the patient frequently demonstrates and assists with repetitive upper limb exercises,
including weightlifting and resistance training, which could contribute to overuse injuries.
Family history:
No relevant family history
Personal History:
Non-smoker
Occasionally consumes alcohol socially
No drug use
PAIN HISTORY:
• Type of pain: Acute
• Site of pain: Left Elbow
• Side of pain: Located on the left lateral side of the elbow, with no radiation of pain.
• Nature/Behavior of pain: The pain is primarily aching in nature, occasionally
described as sharp when performing certain movements, such as lifting weights or
opening jars.
• Severity: Pain severity fluctuates, usually ranging from 3 to 7 on a 10-point visual analog scale,
increasing during and after activities involving wrist extension.
Aggravating Factors: Activities that involve gripping and wrist extension, particularly when demonstrating
exercises or assisting clients with resistance training.
Relieving Factors: Rest and cessation of aggravating activities provide temporary relief. Application of ice also
reduces pain intensity.
ON OBSERVATION:
Built: mesomorph
Gait: normal but reduced arm swing
Posture: Not relevant
Obvious deformity: No
Attitude of limb: Normal
Assisted devices: No
Swelling: yes {mild}
Any other significant finding: No
Physical Examination:
Muscle spasm: No
Tenderness: Marked tenderness directly over the lateral epicondyle
(Grade 2). No warmth is noted
Tightness/contracture: No
Resisted isometric contraction:
Tone: Normal
Reflexes: Intact
Balance and co-ordination: Not relevant
Hand movements: Affected
M.M.T. And Range of motion
Assessment Left Arm (Affected) Right Arm (Unaffected) Notes
Muscle Manual Testing
Wrist Extensors 4/5 5/5 Weakness noted on resisted wrist extension
Wrist Flexors 5/5 5/5 Normal strength
Pronators 5/5 5/5 Normal strength
Supinators 4/5 5/5 Slight weakness noted
Range of Motion
Wrist Flexion 70 degrees 75 degrees Slight restriction noted
Wrist Extension 65 degrees 75 degrees Pain and restriction noted
Elbow Flexion 140 degrees 145 degrees Slightly reduced due to pain
Elbow Extension 0 degrees 0 degrees Normal
Pronation 80 degrees 85 degrees Slight restriction noted
Supination 80 degrees 85 degrees Pain and slight restriction noted
Special Tests:
Cozen’s Test: Positive, producing pain at the lateral epicondyle when the patient makes a fist, pronates the
forearm, radially deviates, and extends the wrist against resistance.

Mill’s Test: Also positive, eliciting pain upon passive stretching of the forearm extensors (forearm pronated and
wrist flexed).

Functional Tests: Difficulty and pain when attempting to perform functional tasks like turning doorknobs or
shaking hands.

Differential Tests
Varus Stress Test: Negative

Purpose: To evaluate the lateral collateral ligament stability.

Elbow Flexion Test: Negative

Purpose: To evaluate for cubital tunnel syndrome.


Investigation:
Recommended for ultrasound
Provisional diagnosis:
Lateral epicondylitis/Tennis elbow
PATIENT MANAGEMENT AND TREATMENT (Brotzman, S. B.,
& Manske, R. C. (2011)
Phase 1: Day 1-14
Goal: Reduce pain and inflammation.
Modalities: Ice application for 8-10 minutes every 2-3 hours.
Laser Therapy: Laser therapy to promote cellular activity and reduce
inflammation.
Manual Therapy: Soft tissue mobilization around the lateral epicondyle to
decrease muscle tension and adhesions.
Activity Modification: Avoid activities that provoke pain, such as heavy lifting
or repetitive wrist extension.
Therapeutic Exercises:
Gentle static stretching of the wrist extensors.
Phase 2: Week 3-6
Goal: Promote tissue healing and begin restoring strength.
Manual Therapy: Soft tissue mobilization around the lateral epicondyle to decrease muscle
tension and adhesions.
Therapeutic Exercises:
Progressive loading of the tendon through controlled isotonic wrist extensor exercises.
Gradual inclusion of eccentric exercises for the wrist extensors.
Modalities: Continue with ice post-exercise to manage inflammation
Activity Modification: Gradual reintroduction of normal activities as pain allows.

Phase 3: Recovery Phase (Week 6-12)


Goal: Restore full strength, flexibility, and function.
Strengthening Exercises:
Increase resistance and complexity of wrist extensor strengthening exercises.
Incorporate functional grip strength exercises.
Begin plyometric and agility drills to prepare for return to full activity.
Stretching: Continue stretching exercises for wrist and elbow
PRECAUTION:
• Use of tennis elbow splint
• Do not over use the hand
• Do not lift heavy objects
• Do not do twisting movements

HOME EXERCISES:
• Use ice pack atleast 3-4 times a day
• Do stretching exercises as prescribed 2 times a day

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