Lateral epicondylitis, also known as tennis elbow, has recently been proposed as lateral elbow (or epicondyle) tendinopathy (LET) is the most common overuse syndrome of the elbow. As the last description suggests, it is a tendon injury involving the extensor muscles of the forearm. these muscles Originates from the lateral epicondyle of the distal humerus.
In many cases, insertion of the extensor carpi radialis brevis muscle is involved.
Often occurs during repetitive upper extremity activities, such as computer use of heavy objects Powerful forearm pronation and supination Unilateral movements in work, such as electrician’s desk-bound work, is often the case.
_ Clinical Presentation
The most prominent symptom of LET is pain on palpation at the origin of the extensor lateral epicondyle. Pain can radiate up the upper arm, down the outside of the forearm, and in rare cases even to the ring and ring fingers.
_ the symptoms
1. Weak pain a few hours after the stimulating activity.
2. Pain at the end or just after the stimulating activity.
3. Persistent pain, prohibition of any activity.
Tennis elbow pain occurs primarily when the tendons of the forearm muscles attach to the bony mass on the outside of the elbow.
_ Activities that may cause tennis elbow.
You can develop tennis elbow through any form of activity, including: twisting the wrist and bending the elbow repeatedly or using the muscles of the forearm.
_ Tennis elbow management .
_Types of Surgery for Tennis Elbow:-
Tennis elbow surgery removes damaged tendons to relieve pain and help you move your elbow more easily.
Surgery can be done in one of two ways, through open surgery or arthroscopy.
Rehabilitation Framework
The management approach for tennis elbow (TE) is adapted from the general principles of tendinopathy rehabilitation.
To achieve long-term goals and meet individual needs, rehabilitation should be a multimodal perspective. We explored the different causes and effects of tennis elbow during our assessment, including centrally sensitized muscle and tendon structural changes and Machine malfunction.
Therefore, it is necessary to investigate all these aspects during history taking and objective examination, and take them into account when designing rehabilitation programs.
The use of multimodal care includes educational exercises, tissue load management, manual therapy, steroid injections, and bandaging.
All of these management strategies can be used and customized based on the patient’s needs, the clinician’s clinical reasoning, and a joint decision between the patient and clinician.
Patient education is defined as “a planned learning experience that incorporates methods such as instructional counseling and behavior modification techniques that influence a patient’s knowledge and healthy behaviors.
Patient education should include the following ideas:
– Avoid extreme range of motion in extension and flexion.
– Avoid repetitive hand and wrist movements and take breaks from these activities if necessary.
– Avoid full extension of heavy objects and arms.
– Lift weights with elbows partially bent.
– Use two hands to hold heavy tools and use a two-handed backhand in tennis.
_ Exercise is essential to increase the tolerance of the tendon to the load. Here are the different ways to do the exercise:
– Elbow and forearm positions begin with flexed elbows and forearm supination, then progress by increasing the angle of elbow extension.
– Finger flexion and extension: Start with finger flexion, then stretch to load the extensors longus.
– Add weight: either with exercise bands or dumbbells.
– Functional training exercises and targeting the entire upper body.
-Weight bearing exercises.
There are some videos explaining exercises and physiotherapy portocols:-
Pain Management
_Manual Therapy:-
Athletic mobilization can be used in conjunction with other measures to reduce pain and promote exercise.
studied the effect of Mulligan on movement in TE and found significant reductions in nocturnal pain and VAS pain and an increase in painless grip strength for up to 3 months after applying the treatment. Another study found that the same approach outperformed wait-and-see and Corticosteroid injections.
