Thursday, April 26, 2012

prognosis and rehabilitation of Tennis Elbow

Tennis elbow, or lateral epicondylitis, is defined as pain and inflammation of the attachment of the base extensor muscle tendon to the lateral epicondyle of the humerus bone due to degeneration, injury, or tendonosis. The injury is most often related with swinging a tennis racket but the majority of the occurrences are not sport related. Plumbers, carpenters, mechanics, typists, cashiers, and those who work at computers are often affected. base activities that lead to tennis elbow contain repetitive overuse, repetitive extension and flexion of the fingers seen in typing, repetitive wrist flexion seen in hammering and racket sports, repetitive wrist extension and supination as seen with working with screwdrivers and turning door knobs, and repetitive medial and lateral deviation of the wrist much like when grocery store clerks scan items at the check out counter. Tennis elbow accounts for about 90% of all elbow tendinitis with medial epidondylitis accounting for the other 10%. The onset of the injury is regularly gradual unless there is trauma. The pain is focally located nearby the insert of the tendon into the lateral epicondyle but can radiate distally into the muscles of the forearm. There can be a loss of drive in the forearms and hands present but not always. Active and passive ranges of petition in the wrist and elbow will often be full with no pain but resisted muscle testing will reproduce pain in the elbow especially resisted wrist extension.

Trigger Finger Surgery

To truly understand the cause of tennis elbow injuries you have to understand the underlying anatomy and pathophysiology of the involved structures. The elbow is essentially a hinge joint that has limited rotational capabilities. This dual function of the elbow joint makes it a involved joint and susceptible to injuries. The three bones of the elbow are the humerus, radius, and ulna. The lateral epicondyle is the bony angle of the humerus on the outside of the arm, in line with the back of the hand, just above the elbow joint. The muscles of the forearm that are responsible for the symptoms of Tennis Elbow cross the elbow joint and end in one tendon that attaches to the lateral epicondyle of the humerus. The major muscles that come off the base extensor tendon are the extensor carpi ulnaris, extensor digiti minimi quinti, extensor digitorum profundus, and extensor carpi radialis brevis. Those muscles insert into the medial side of the of the base of the 5th metacarpal, into the extensor profundus sheath, the extensor expansion of digits 2-5, and the dorsum of the 3rd metacarpal bone respectfully. Together they work to extend the wrist and 2nd-5th digits. The most base cause of Tennis Elbow is over-use of the muscles which attach to the lateral epicondyle of the humerus, just above the elbow joint. In other words, if the extensor or rotator muscles of the hand, wrist, and forearm are strained or over-used, they come to be irritated, inflamed, and swollen. This produces pain and tenderness at the lateral epicondyle of the humerus. If allowed to progress, the tendon develops small tears in it at its attachment to the humerus. By this time, the pain is quite intense. This is the point at which most habitancy seek advice about this condition. The development of tennis elbow often relates to the way that workers and sports enthusiasts carry out activities such as gripping, twisting, reaching, and moving. These activities can come to be risky when they are done in a fixed or awkward position, with constant repetition, or with excessive force without allowing the body to recover from the wear and tear that these activities cause. Tennis elbow is related with activities that require repeated or forceful movements of the fingers, wrist, and forearm. It can invent because of too much force at once or small amounts of force for too long a period.

Treatment of Tennis Elbow often begins with Rice protocols where the elbow is rested, iced, compressed, and elevated to promote drainage and decrease localized inflammation and swelling at the point of injury. If the pain persists or worsens following 2-3 weeks of these guidelines then it should be examined by a health care pro to decree if extra rehabilitation is needed. In severe cases or when original conservative treatments do not help, an Mri is needed to check for serious tears in the tendon or injury to the bone. Surgical fix is sometimes needed but should only be done after less invasive methods have failed. Some orthopedic doctors recommend pain injections when conservative methods have failed before performing surgery. Conservatively this injury can be successfully treated by corporeal therapists, chiropractors, and manual therapy practitioners. Soft tissue therapy of the involved muscles of the forearm and hands is very beneficial and includes massage, trigger point therapy, myofascial release, and muscle stripping. Manipulation of the elbow and bones of the arm and wrist are helpful to relax stress form the tissues and corporeal therapy modalities along with therapeutic ultrasound, microcurrent, and electric muscle stimulation can help sacrifice inflammation and swelling and sacrifice pain. Chopat braces and taping are used to stabilize the joint and to limit petition in order to relax stress from the extensor tendon. Home stretches should be done to lengthen the extensor muscles of the forearm and hand followed by strengthening exercises to build back elbow and hand strength. Exercises should not be prescribed while in the acute phase of injury in order to avoid exacerbating the injury. Faultless curative could take anywhere form 4-8 weeks depending on the severity of the injury and lifestyle modifications must be taken following rehabilitation in order to avoid aggravating or reinjuring the elbow. This may contain changing work or recreational activities to avoid the above listed causes.

1 comment:

  1. stenosing tenosynovitis or trigger finger can be extremely painful and could end in surgery if you dont take the proper precautions. Get it fixed now.

    good luck!

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