Elbow Epicondylitis Overview
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Questions and Answers

What is the primary cause of lateral epicondylitis?

  • Contractile overloads that chronically stress the tendon (correct)
  • Inflammation of the elbow joint
  • Direct trauma to the elbow
  • Tendon rupture

Which muscle is most affected in lateral epicondylitis?

  • Extensor carpi radialis longus
  • Extensor digitorum
  • Extensor carpi radialis brevis (correct)
  • Supinator

In which age group is lateral epicondylitis most commonly diagnosed?

  • Seniors aged 65 and older
  • Adults aged 35-50 (correct)
  • Children under 12
  • Young adults aged 18-25

What percentage of people with tennis elbow can relate the injury to playing tennis?

<p>5% to 10% (C)</p> Signup and view all the answers

What complication is associated with lateral epicondylitis?

<p>Persistent pain in 20% of cases lasting more than a year (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of lateral epicondylitis?

<p>It primarily involves the wrist flexor muscles (B)</p> Signup and view all the answers

What is a potential mechanism for the susceptibility of the extensor carpi radialis brevis to chronic inflammation?

<p>Fulcrum effect when the elbow is extended and fully pronated (D)</p> Signup and view all the answers

What is the primary focus of the manipulation techniques that may benefit patients with lateral epicondylalgia (LE)?

<p>Reducing altered neuronal afferent input to the spine (D)</p> Signup and view all the answers

Which exercise technique should be employed first for strengthening the wrist extensors in lateral epicondylalgia?

<p>Low intensity isometric exercises (D)</p> Signup and view all the answers

What anatomical position is recommended for the best stretching of the Extensor Carpi Radialis Brevis tendon?

<p>Elbow in extension, forearm in pronation, wrist in flexion with ulnar deviation (C)</p> Signup and view all the answers

What is the proposed benefit of cervicothoracic joint mobilization when combined with local treatment for lateral epicondylalgia?

<p>Improvements in strength, pain, and activity tolerance (C)</p> Signup and view all the answers

Which of the following best describes the method of manipulation after inflammation decreases in the treatment of lateral epicondylalgia?

<p>Gradual increase in intensity during cross fiber massage (C)</p> Signup and view all the answers

Under what specific conditions is the ECRB under the greatest strain?

<p>Forearm pronation with wrist flexion and ulnar deviation while the elbow is extended (B)</p> Signup and view all the answers

Which of the following is NOT a risk factor for developing tennis elbow?

<p>Poor nutrition and hydration (A)</p> Signup and view all the answers

What is recommended for reducing wrist or finger oedema?

<p>Elevation of the extremity (A)</p> Signup and view all the answers

Which activity modification is suggested to prevent wrist strain?

<p>Hand grasping in supination (A)</p> Signup and view all the answers

Which condition is primarily caused by overuse of the wrist extensors?

<p>Lateral epicondylitis (A)</p> Signup and view all the answers

What is a common symptom of lateral epicondylitis?

<p>Dull aching pain at rest that may become sharp during activity (A)</p> Signup and view all the answers

What is one benefit of the diamond taping method using rigid tape?

<p>It improves grip strength and functional performance (B)</p> Signup and view all the answers

Why might a tennis player use two hands during a backhand stroke?

<p>To reduce loading on the wrist extensors (C)</p> Signup and view all the answers

What is NOT a proposed cause of lateral epicondylitis?

<p>Excessive stretching (D)</p> Signup and view all the answers

What equipment change may help prevent recurrent symptoms in tennis players?

<p>Choosing a smaller racquet head (D)</p> Signup and view all the answers

Which symptom is associated with difficulty in carrying objects?

<p>Weak grip strength with an extended elbow (D)</p> Signup and view all the answers

What type of activity is particularly associated with the development of tennis elbow in non-athletes?

<p>Repetitive manual labor and hobbies (C)</p> Signup and view all the answers

Which of the following modalities can be applied for treating tendonopathies?

<p>US iontophoresis and phonophoresis (C)</p> Signup and view all the answers

What sign is NOT typically related to tennis elbow?

<p>Redness and swelling around the wrist (B)</p> Signup and view all the answers

What technique involves exposing patients to mechanical wave impulses?

<p>Shockwave Therapy (C)</p> Signup and view all the answers

Which activity is likely to lead to tennis elbow due to repetitive stress?

<p>Housework involving wrist extension (D)</p> Signup and view all the answers

What is a recommended technique to manage fascial restrictions in the body?

<p>Deep friction massage (C)</p> Signup and view all the answers

Which advice is essential for someone experiencing forearm strain in racquet sports?

<p>Modify activities to reduce exacerbating actions (B)</p> Signup and view all the answers

What role does ergonomic counseling play in managing forearm strain?

<p>It provides information on injury prevention and activity modification (C)</p> Signup and view all the answers

What is the primary focus when evaluating wrist extensors and shoulder muscles in the context of upper extremity injuries?

<p>Shoulder and scapular strength, motion, and stabilization (C)</p> Signup and view all the answers

Which test would be indicated to assess pain related to the extensor digitorum communis?

<p>Maudsley test (A)</p> Signup and view all the answers

What indicates a positive result in Cozen's test?

<p>Pain in the lateral epicondyle upon wrist extension resistance (C)</p> Signup and view all the answers

How might ultrasound examination be utilized in diagnosing lateral elbow pain?

<p>To demonstrate tendon damage and presence of a bursa (A)</p> Signup and view all the answers

During the Chair lift test, when would a test be considered positive?

<p>Pain at the lateral epicondyle while pinching (D)</p> Signup and view all the answers

What common finding may be seen on plain X-ray of the elbow for longstanding cases of lateral elbow pain?

<p>Calcification along the lateral epicondyle (A)</p> Signup and view all the answers

What is the purpose of electromyography (EMG) in the context of tennis elbow diagnosis?

<p>To rule out nerve compression (C)</p> Signup and view all the answers

In Mill’s Tennis Elbow Test, when is the test considered positive?

<p>When pain occurs during passive elbow extension (A)</p> Signup and view all the answers

Which statement is true regarding the relationship between shoulder dysfunction and elbow injuries?

<p>Shoulder dysfunction can frequently lead to elbow overuse injuries. (C)</p> Signup and view all the answers

What is the recommended method to assess pain when performing specific daily activities for tennis elbow?

<p>Visual analog scale (C)</p> Signup and view all the answers

Flashcards

Lateral Epicondylitis (Tennis Elbow)

An overuse syndrome affecting the extensor muscles of the forearm, commonly seen near the lateral epicondyle of the humerus. It is typically caused by repetitive stress on the tendons.

Etiology of Lateral Epicondylitis

Caused by chronic overloading on the tendons, near the attachment point on the humerus, often from repetitive microtrauma. It is not an inflammatory condition.

Risk Factors for Lateral Epicondylitis

Repetitive wrist extension activities, commonly seen in adults aged 35-50. The dominant arm is more susceptible, and the condition is often linked to activities that involve repetitive actions.

Extensor Carpi Radialis Brevis (ECRB)

The primary muscle affected in lateral epicondylitis. It originates from the lateral epicondyle of the humerus, involved in wrist extension.

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Lateral Elbow (or Epicondyle) Tendinopathy (LET)

A proposed, more accurate alternative term for Tennis elbow, emphasizing that it's not an inflammation but a tendon issue.

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Treatment for Lateral Epicondylitis

Treatment methods vary, but common approaches might involve rest, physical therapy, and possibly other strategies to manage and relieve the symptoms.

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Medial Epicondylitis

A condition affecting the tendons near the medial epicondyle, frequently from repetitive wrist flexion activities.

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Palpation of a scar

The process of feeling a scar with your fingers to assess its texture, size, and any tenderness.

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Cross-fiber massage

A massage technique used to break down scar tissue and improve tissue mobility. It involves rubbing the scar in a direction perpendicular to the scar tissue.

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What is the effect of joint manipulation in LE?

It has shown clinical improvements in pain and motor function, possibly due to altered neuronal afferent input to the spine.

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Cervicothoracic joint mobilization

A treatment technique involving manual mobilization of the joints in the neck and upper back region, often used alongside local treatment for lateral epicondylitis.

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Mulligan - Mobilisation with movement

A technique where the therapist mobilizes a joint while the patient simultaneously performs a controlled movement.

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Tennis elbow risk factors

Factors that increase the likelihood of developing tennis elbow, including handling heavy objects repetitively, excessive repetitive movements, improper technique, and certain health conditions.

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Tennis elbow etiology

The cause or origin of tennis elbow, often linked to overuse or direct impact on the lateral epicondyle, leading to inflammation, micro-tears, or degeneration in the forearm extensor muscles.

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Tennis elbow symptom

Pain located on the lateral epicondyle, radiating along the forearm, often aggravated by wrist extension or gripping.

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ECRB strain

The ECRB (extensor carpi radialis brevis) muscle is stressed and strained when the forearm is pronated, the wrist is flexed and deviated toward the pinky finger (ulnar deviation), and the elbow is extended.

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Lateral epicondylitis symptom

Pain is felt on the outside of the elbow, and worsens with active wrist extension or gripping. Symptoms may extend into the upper or lower arm areas.

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Overuse injury

An injury caused by repeating the same action several times over a given period, which can damage muscles, tendons, and ligaments until they hurt.

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Pain location, lateral epicondylitis

Pain is primarily located on the outside of the elbow, near the bony prominence (lateral epicondyle), and may radiate into the forearm.

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Direct blow injury

An injury resulting from a direct forceful impact on the body part involved.

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Wrist extensor muscles

The muscles responsible for extending (straightening) the wrist.

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Tennis Elbow Provocative Tests

Tests used to identify the cause of pain in the lateral elbow region, specifically tennis elbow.

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Cozen's Test

Resisted wrist extension test to evaluate lateral epicondylitis (tennis elbow).

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Mill's Test

Passive elbow extension with pronated forearm and flexed wrist to assess lateral epicondylitis.

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Maudsley Test

Resisted middle finger extension to assess extensor digitorum communis involvement in elbow pain

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Chair Lift Test

Evaluates elbow pain during chair lifting with a three-finger pinch and extended elbow.

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Coffee Cup Test

Evaluates pain during specific activities like picking up objects, in a clinical setting.

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Lateral Epicondylitis

Inflammation of the tendons on the outside of the elbow (tennis elbow).

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Ultrasound Examination

Imaging technique to evaluate tendon damage in lateral elbow pain.

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Electromyography (EMG)

Test to rule out nerve compression in the elbow, differentiate from tennis elbow.

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Upper Extremity Kinetic Chain

Interconnected series of joints and muscles in the upper body, affected in faulty movement.

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Wrist Elevation

Raising the affected arm above the heart to reduce swelling (edema) in the wrist or fingers.

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Kinesio Tape Application

Applying Kinesio tape on a pronated arm with the wrist flexed, from the ECRB muscle's insertion to origin.

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Education/Advice for Lateral Epicondylitis

Informing the patient about their condition, pain management, activity modifications, and lifestyle changes to avoid aggravation.

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Activity Modifications for Lateral Epicondylitis

Avoiding activities that put stress on the wrist extensors. Examples include lifting with a palm down grip, pronation motions, and straight elbow lifting.

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Backhand Technique in Tennis

Using a flexed elbow during a backhand stroke to reduce impact load on the wrist extensors.

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Equipment Check for Lateral Epicondylitis

Evaluating and adjusting sports equipment, like racquet stiffness and grip size, to reduce stress on the forearm.

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Modalities for Lateral Epicondylitis

Therapeutic options including electrical and thermal treatments, US iontophoresis, phonophoresis, laser therapy, and Shockwave Therapy.

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Myofascial Release

A manual therapy technique that addresses fascial restrictions to relieve tension throughout the body.

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Deep Friction Massage

A manual therapy technique that involves deep pressure massage on the affected area to improve blood flow and break down scar tissue.

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Shockwave Therapy

A treatment method for tendonopathies, including lateral epicondylitis, using strong mechanical wave impulses to promote healing.

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Study Notes

Elbow Epicondylitis

  • Tennis Elbow (Lateral Epicondylitis): Also known as lateral epicondylitis, this condition causes pain on the outside of the elbow.
  • Golfer's Elbow (Medial Epicondylitis): Also called medial epicondylitis, this condition causes pain on the inside of the elbow.

Lateral Epicondylitis

  • Definition: Lateral epicondylitis, commonly known as tennis elbow, is a tendinopathy (tendinosis and tendon degeneration) affecting the extensor muscles of the forearm, originating from the lateral epicondyle of the distal humerus. It is typically an overuse syndrome.

  • Etiology: Chronic stress on the tendon, especially near its attachment to the humerus, is the primary cause. Repetitive or forceful wrist extension or activities involving the extensor muscles lead to the condition.

  • Risk Factors: Activities involving repetitive motions, such as using hand tools, handling heavy objects, playing racquet sports (particularly tennis), or even certain types of training errors. Age between 35-50 is a common demographic for diagnosis. Affects between 1%-3% of the population and is equally common in both sexes.

  • Clinical Presentation: Pain is often present when palpating the lateral epicondyle area. Pain radiates up the upper arm and down the forearm's outer side. Dull ache at rest and sharp pain during activity or movements like wrist extension. Related to increase/increase in wrist extensor activity. Morning stiffness and occasional night pain can occur. The dominant arm is more likely to be affected. 20% of cases last longer than a year.

  • Provocative Tests: Cozen's test, Mill's test, Maudsley test, and chair lift test.

  • Diagnosis: Medical history, physical examination, and possible ultrasound examination to assess tendon damage. X-rays might be used to rule out other conditions. Electromyography (EMG) may rule out nerve compression.

  • Treatment: Anti-inflammatory medication, cortisone injections, Autologous blood injections(ABI/PRP). Physiotherapy interventions are common (including modalities like electrical and thermal stimulation, US iontophoresis, phonophoresis, laser therapy) and manual therapies for myofascial release. Possible surgical intervention after prolonged non-surgical treatment.

Medial Epicondylitis

  • Definition: Medial epicondylitis, often termed "golfer's elbow", results from repetitive strain on the tendons that flex the wrist. It's a common condition affecting the pronator teres and flexor carpi radialis muscle tendons near the medial epicondyle of the humerus.

  • Etiology: Similar to lateral epicondylitis, this is an overuse syndrome stemming from repetitive microtrauma from using tendons that flex the wrist, predominantly involving activities like pronation and the wrist flexion.

  • Risk Factors: Repetitive activities such as using tools, gardening, and overhead work, plus certain sports can lead to this condition.

  • Clinical Presentation: Pain radiating from the medial epicondyle of the humerus (inside of the elbow), most common to the ulnar side of the forearm, and sometimes to the fingers; a weakness of the grip; pain from resisting flexion of the wrist; pronation; or during shaking hands or opening heavy doors (passive extension). Associated pain often accompanies a weakness of the hand grip. Swelling and tenderness to the touch (over pronator teres and flexor carpi radialis) may accompany the condition.

  • Provocative Tests: Tests used in evaluation include resisted flexion or wrist extension, when the elbow is stabilized.

  • Diagnosis: Similar diagnostic approach as for lateral epicondylitis using medical history, examination, and possibly imaging.

  • Treatment: Treatment is usually similar to lateral epicondylitis in approach although specific exercises to support pronator teres and flexor carpi radialis muscles will be more involved.

General Notes

  • Activity Modification: Important lifestyle changes to reduce aggravating activities, including ergonomic counseling. Avoid actions that cause sudden or excessive stress on the involved joints

  • Tennis Player Considerations: Educating players on proper backhand techniques to prevent overuse. Proper equipment selection (grip size and string tension in racquets) can reduce strain on the forearm muscles when using sports equipment.

  • Goals of Physical Therapy: Short term goals are decreasing pain, decreasing inflammation, promoting tissue healing, and maintaining ROM(range of motion) and flexibility. Long term is focused on improving flexibility, increasing strength, enhancing muscular endurance and increasing functional movements to return to activity and reduce muscle atrophy.

  • Equipment/Brace: Protecting the involved area with braces or splints may be utilized. The goal of braces should be to limit full muscular expansion and reduce compressive forces on the affected area.

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Elbow Epicondylitis 2025 PDF

Description

This quiz explores the conditions of elbow epicondylitis, focusing on tennis elbow and golfer's elbow. It covers definitions, causes, risk factors, and the underlying mechanisms of these overuse syndromes. Test your knowledge about this common musculoskeletal condition.

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