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Tennis Elbow/ Lateral Epicondylitis

  1. Enteropathogenesis
    1. It is chronic tendonitis of common extensor origin (esp. extensor carpi radialis brevis) on lateral epicondyle.
    2. It may result in small tears, fibrocartilage nous metaplasia, microscopic calcification and painful vascular reaction in tendon fibers close to lateral epicondyle (degenerative changes with angiofibroblastic proliferation)
  2. Clinical Feature
    1. Patient is usually an active individual of 30-40 years. Pain comes on gradually, often after a period of unaccoustomed activity involving forceful gripping & wrist- extension.
    2. Pain is localized to lateral epicondyle aggrevated by movements such as pouring out tea, turning a lifting with pronated forearm.
    3. Localized tenderness at or just below lateral epicondyle.
    4. Pain can be reproduced by Active extension of wrist against resistance (Cozen’s test)
    5. Treatment include steroid injection if not resolved than detachment of common extensor origin.

Description: TennisElbowlabel

Description: download (15)

Tennis elbow: Inflammation at lateral epicondyle 

Cozen Test

 

Treatment:

 

Description: images (9)

Description: images (10)

Description: images (11)

Tennis elbow brace

Ultrasonic therapy / Lesser therapy

Steroid injection (Intralesional)

De Quervain’s Disease

  1. Also called washerwomen’s thumb
  2. The abductor pollicis longns and extensor pollicis brevis tendonsQ may become inflamed beneath the retinacular pulley at the radial styloid with in the first extensor compartment.
  3. It may be initiated by overuse or may follow unaccoustomed new activity. Symptoms are provoked by lifting activity in which the thumb is adducted & flexed while while the hand is ulnarly deviated - Finkeistein’s test.
  4. Sometimes, there is a visible swelling over distal end of radius and tendon sheath feels thick and hard.
  5. Tenderness is most acute at the very tip of radial styloid.
  6. Differential diagnosis include scaphoid non-union, arthritis at the base of thumb and intersection syndrome.
  7. Treatment includes immobilization with forearm based thumb spica (preventing wrist deviation, thumb CMC and MP joint motion while allowing interphalangeal joint motion), steroid injection and if not relieved splitting the thickened tendon sheath.

Description: De-Quervain's-Tenosynovitis

Description: deQuervains-2

Description: de-quervains_2

First extensor compartment

APL, EPB tendons inflamed

Finkeistein’s test

Wrist brace


Extensor compartment of wrist

 

Description: download (4)
 

Compartment

Content

Disease

1.

APL, EPB

De Quervains

2.

ECRL,ECRB

Intersection syndrome

3.

EPL

Rupture(colles fracture)

4.

EDC,EIP

tenosynovitis

5

EDM

Rupture (RA=Vaughan synd)

6

ECU

Snapping ECU





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