Tennis elbow or lateral epicondylitis is painful condition in lateral epicondyle then pain spread into the forearm and wrist. it is pathological inflammation occur in extensor tendons of hand as extensor carpi radialis longus and brevis as well as extensor digitorum communis. The most muscle affected in tennis elbow is extensor carpi radialis brevis . the inflammation is present in all extensor muscles of hand but in specific in extensor carpi radialis brevis .
Tennis elbow is consider over use syndrome or in another meaning it occur due to repeated movement. The repeated movement leads to microtears. This disease starts with inflammation in acute stage then finally in chronic stage, the inflammation converts to fibrosis. So, it is so important, this problem is treated in acute stage before the inflammation convert into the fibrosis.
- In the fact, tennis elbow occur commonly in repeated motion of gripping activities . it occur from sports as tennis, Racquetball, squash, fencing and weight lifting.
- Not only sports but also other jobs that require repetitive arm movements or gripping such as carpentry, typing, painting, Raking, knitting and Dentist.
signs and symptoms:
2-Tenderness in the lateral epicondyle
3-The pain may radiate on the forearm and that will affect on the functional activities .
How to diagnose:
By special tests , its aim to aggravate pain by doing either resist action or stretch the muscle.
The first special test is mills test ( stetch extensor carpi radialis brevis )
- Do extention elbow, flexion wrist , flexion finger and ulnar devition.
The second special test is cozen test ( resist action )
- Do extention elbow and radial deviation with pronation
the third special test called maudsley test ( this test is high sensitivity for patient with tennis elbow )
- Give order to patient to do extention in wrist and extention in the middle finger.also you can give resistance to patient on the middle finger.
NB: this test concentrate on the middle finger because this is the insertion of extensor carpi radialis brevis ( base of middle metacarpal )
The most important ttt in tennis elbow is activity modification:
Try to avoid repetitive pronation and supination. Avoid grasping in pronation and do substitution controlled supination lifting .
In acute stage:
The goal in this stage to reduce pain and inflammation , promote healing and increase flexibility.
1-Tennis elbow support
put it on the affected area for 10-15 min for 4-6 time per day
5- Iontophoresis – phonophoresis
6-Stretch wrist extensor
In sub acute or chronic stage ( once pain sub side):
The goal in this stage to stretch and strength the muscles.
1- Deep friction massage:
2- Stretch the wrist and elbow extensors
3- strength the muscles ( concentric eccentric strength)
NB: the most recent researches proved that importance of eccentric contraction in preventing the recurrent injury
also, we should concentrate on hand grip by squeez the tennis ball and hold in this position for 15 sec.we should strength the supination movement by weight.also, we should do strength after the stretching of muscles due to the stretch do some weakness in the muscle so we should strength it.
4- Return gradually to function
5- Mill’s manipulation
it is very common and useful in treatment of tennis elbow. it is used after Deep friction massage , the combination between Deep friction massage and mills manipulation called cyriax method .
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