Tennis elbow

1. TENNIS ELBOW

2. TENNIS ELBOW TENNIS ELBOW SYNDROME ENCOMPASSES LATERAL , MEDIAL AND POSTERIOR ELBOW SYMPTOMS. COMMONLY ENCOUNTERED IS LATERAL TENNIS ELBOW-KNOWN AS CLASSICAL TENNIS ELBOW IT IS THE PAIN AND TENDERNESS ON THE LATERAL SIDE OF THE ELBOW SOME ARE WELL DEFINED AND SOME VAGUE,THAT RESULTS FROM REPETITIVE SRESS

3. OTHER VERIETIES MEDIAL TENNIS ELBOW (GOLFERS ELBOW) INFLAMMATION AT THE ORIGIN OF FLEXOR TENDONS AT THE MEDIAL EPICONDYLE OF THE HUMERUS POSTERIOR TENNIS ELBOW-AROUND THE MARGINS OF OLECRANON PROCESS

4. LOCATION OF PAIN IN T.ELBOW LATERAL EPICONDYLE (75%) LATERAL MUSCLE MASS (17%) MEDIAL EPICONDYLE (10%) POSTERIOR (8%)

5. LATERAL TENNIS ELBOW IT IS THE LESION AFFECTING THE TENDINOUS ORIGIN OF COMMON WRIST EXTENSORS MEN>WOMEN BELIEVED TO BE A DEGENERATIVE DISORDER

6. CAUSES EPICONDYLITIS-DUE TO SINGLE OR MULTIPLE TEARS IN THE COMMON EXTENSOR ORIGIN,PERIOSTITIS,ANGIOFIBROBLASTICPROLIFERATION OF ECRB etc INFLAMMATION OF ADVENTITIOUS BURSA-BETWEEN COMMON EXTENSOR ORIGIN AND RADIOHUMERAL JOINT. CALCIFIED DEPOSITES WITH IN THE COMMON EXTENSOR TENDON

7. CAUSES PAINFUL ANNULAR LIGAMENT-DUE TO HYPERTROPHY OF SYNOVIAL FRINGE BETWEEN RADIAL HEAD AND CAPITULUM PAIN OF NUEROLOGICAL ORIGIN-CS AFFECTION,RADIAL NERVE ENTRAPMENT etc

8. ECRB IS THE MOST COMMON INVOLVED STRUCTURE IN L.E MORE COMMON IN THE DOMINATED ARM

9. SEEN IN ALL LEVELS OF TENNIS PLAYERS(UP TO 50% AT SOME TIME IN CAREER). IT IS MORE COMMON IN NON TENNIS PLAYERS(95%). SEEN IN OTHER SPORTS ALSO (THROWING SPORTS , SWIMMING) OCCUPATIONAL-CARPENTARY , PLUMPING , TEXTILE WORKERS HOUSE WIVES(SQUEEZING CLOTHES)

10. PATHOPHYSIOLOGY AND RELATED SYMPTOMS STAGE I : ACUTE INFLAMMATION BUT NO ANGIOBLASTIC INVASION(PT C/O PAIN DURING ACTIVITY) STAGE II:C/C INFLAMMATION+SOME ANGIOBLASTIC INVASION(PAIN BOTH DURING ACTIVITY AND REST) STAGE III:C/C INFLAMMATION WITH EXTENSIVE ANGIOBLASTIC INVASION(REST PAIN,NIGHT PAINS ,PAIN DURING DAILY ACTIVITIES)

11. CLINICAL TESTS LOCAL TENDERNESS ON THE OUTSIDE OF THE ELBOW AT THE C.E.O WITH ACHING PAIN IN THE BACK OF FOREARM COZENS TEST:PAINFUL RESTRICTED EXTENSION OF WRIST WITH ELBOW IN FULL EXTENSION ELICITS PAIN AT THE LATERAL ELBOW. ELBOW HELD IN EXTENSION,PASSIVE WRIST FLEXION AND PRONATION PRODUCES PAIN. MAUDSLEYS TEST:RESTRICTED EXTENSION OF MIDDLE FINGER ELICITS PAIN AT THE LATERAL EPICONDYLE DUE TO DISEASE IN THE EXTENSOR DIGITORUM COMMUNIS

12. RADIOGRAPHY AP , LATERAL , RADIOCAPITELLAR VIEWS 16% CASES FAINT CALCIFICATION ALONG L.E

13. TREATMENT CONSERVATIVE MANAGEMENT REST AND PHYSIOTHERAPY (50-75%) CHANGING TENNIS STROKES (92%) STREATCHING EXERCISES (84%) USE OF SPLINTS (83%) NSAIDS (85%) INJECTION OF LOCAL ANAESTHETIC AND STEROID BOTULINUM TOXIN TYPE A TO PARALYZE THE COMMON EXTENSOR ORIGIN THAT HAS NOT IMPROVED WITH CONSERVATIVE MEASURES

14. MILLS MANOEUVRE 10% OF CASES DO NOT RESPOND TO CONSERVATIVE MANAGEMENT A FORCEFUL EXTENSION OF A FULLY FLEXED AND PRONATED FOREARM AFTER INJECTION

15. SURGICAL METHODS PERCUTANEOUS RELEASE OF EPICONDYLAR MUSCLES BOSWORTHTECHNIQUE OF EXICION OF PROXIMAL PORTION OF ANNULAR LIGAMENT,RELEASE OF THE ORIGIN OF EXTENSOR MUSCLES,EXCISION OF THE BURSA AND EXCISION OF SYNOVIAL FRINGES.

16. NEW TREATMENT MODALITIES USE OF EXTRACORPOREAL SHOCK WAVE THERAPY(ESWT) CASES OF FAILED CONSERVATIVE TREATMENT FOR ATLEAST 6 MONTHS 2000 SHOCK WAVES THREE TIMES AT MONTHLY INTERVALS FOR 6 MONTHS ARTHROSCOPIC RELEASE:OF ECRB WITH FAILED CONSERVATIVE TREATMENT FOR 6 MONTHS.MINIMALLY INVASIVE AND HELPS IN EARLY REHABILITATION.

17. NEW TREATMENT MODALITIES AUTOLOGUS BLOOD INJECTIONS:IN REFRACTORY CASES,INJECTION OF 2 ML OF AUTOLOGUS BLOOD AND 0.5% BUPIVICAINE HAS BEEN TRIED COUNTERFORCE BRACING(TENNIS ELBOW OR FOREARM BAND):THESE FORCES RELEASE THE FORCES IN THE ECRB REGION REHABILITATIVE EXERCICES:WRIST FLEXION , EXTENSION,FOREARM SUPINATION AND PRONATION,WRIST RADIAL AND ULNAR DEVIATIONS AT 3 SETS OF 10 REPETITIONS EVERYDAY FOR 3 TO 6 MONTHS(KNOWN TO GIVE GOOD RESULTS)

18. NEW TREATMENT MODALITIES USG GUIDED PERCUTANEOUS NEEDLE THERAPY :USG GUIDED CORTICOSTEROID INJECTION AND NEEDLE DEBRIDEMENT OF THE STRUCTURES AROUND LATERAL EPICONDYLE. INDICATION:SMALL TEARS,NOT RESPONDING TO CONSERVATIVE THERAPY AND IF TOO SMALL FOR SURGERY ADVANTAGES :MINIMALLY INVASIVE PROCEDURE RESTORATION OF FUNCTION IS RAPID THE OPTION OF SURGERY IS STILL OPEN IN EXPERT HANDS IT HAS SUCCESS RATE OF 65%

19. PROGNOSIS RESPONSE TO INITIAL THERAPY IS COMMON,BUT SO ARE RELAPSE(18-50%)AND /OR PROLONGED,MODERATE DISCOMFORT(40%)

20. THANK YOU