Surgical management of tennis elbow

Post graduate lecture series for orthopaedics

1. TENNIS ELBOW BY  ATANU KAYAL JR  dept of ORTHOPAEDICS, BMC&H

2. WHAT IS TENNIS ELBOW(LATERAL EPICONDYLITIS)?

3. Lateral epicondylitis

4. CLINICAL DIAGNOSIS Diagnosis is made by localizing discomfort to the origin of ECRB. Tenderness typically present over lateral epicondyle approximately 5 mm distal and  anterior to the midpoint of condyle. Pain usually exacerbated by resisted wrist dorsiflexion and forearm supination and  pain when grasping objects. Click to add text

5. Clinical test COZENS TEST also known as resisted wrist extension test or resistive tennis elbow test. The patient should be seated, with the elbow extended forearm maximal pronation, wrist radially abducted, and hand in a fist and The doctor should stabilize elbow while palpating lateral epicondyle, other hand placed on the dorsum of the hand. The patient is asked to move the wrist to dorsal flexion and the doctor  provides resistance to this movement,  The test is said to be positive if a resisted wrist extension triggers pain to the lateral aspect of elbow.

6. IMAGING

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8. TREATMENT of tennis elbow NONOPERATIVE  treatment Nonoperative treatment is successful in 95% patients. Initial nonoperative treatment includes...REST, ICE, INJECTIONS OF STEROID,PHYSICAL THERAPHY with ultrasounds, stretching and strengthening exercise and COUNTERFORCE BRACING and Extra corporal shock wave therapy(ECSWT) PRP injections more effective than corticosteroid injections in relieving pain and improve function but some studies found that autologous blood injections were more successful than PRP. Click to add text

9. SURGICAL TREATMENT IF non operative treatment ineffective more than 6 to 12 months, operative treatment may be considered. Percutaneous lateral release has been reported to be effective as open release. Arthroscopic release also equally effective as open procedures.

10. NIRSCHL, MODIFIED TECHNIQUE for correction of tennis Elbow

11. Postoperative care

12. REHABILITATION PROTOCOL for EPICONDYLITIS

13. Phase …..

14. Thank you