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Tennis Elbow - Coggle Diagram
Tennis Elbow
diagnosis
take history ask about red flags such as history of trauma, joint swelling, or systemic symptoms which may suggest alternate diagnosis
severe onset duration and exacerbating features of the pain such as: symptoms that often onset without any clear precipitating event, but may follow an injury or increased levels of activity
pain or burning sensation typically presents in the dominant arm, in the region of the lateral epicondyle with radiation down the extensor aspect of the forearm, and occasionally proximally into the upper arm, symptoms are usually exacerbated by repetitive wrist movement
occupational and recreational activities that may provoke symptoms and may have precipitated the problem such as construction work, assembly line work, using vibrating tools, typing, playing piano, playing tennis or kayaking.
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daily function impact such as raising a cup shaking hands, shaving or lifting bags
sleep disturbance, anxiety or depression
examine the person
assess for red flag features such as swollen, red tender joints.
look for typical features such as: localized point tenderness on palpation over and or distal to the lateral epicondyle and along the common extensor tendons
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dorsiflex the wrist against resistance with the elbow flexed at 90 degrees - extending the elbow increases pain further
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check for tinels signs - tap lightly on the medial elbow over the ulnar nerve, it is positive if testing generates paraesthesia without pain. a negative tinels signs can help rules out cubital tunnel or other neurological conditions
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Differential diagnosis
rheumatoid arthritis, septic arthritis - may be hot, tender or swollen joints.
cervical radiculopathy - may cause neck pain, numbness or muscle weakness affecting C6-8 distribution
elbow arthropathy - elbow osteoarthritis, most commonly affects radio capitellar joint and typically presents with joint stiffness, loss of flexion and extension with end range pain
osteochondritis dissicans of the capitellum - may present with joint effusion more common in younger people especially following repetitive overhead throwing activities
radial tunnel syndrome - maximal tenderness is localised to the area distal to the radial head, pain often worse at night resisted wrist extension may not be painful however resisted thumb and index finger extension may cause pain.
trauma and intra articular loose bodies - elbow stiffness, deformity, swelling, or soft tissue damage, may suggest and old or new traumatic injury, clicking or limitations of range of movement may suggest loose bodies
malignancy - may be suggested by bone pain, an increase mass or swelling
posterior interosseous nerve entrapment syndrome posterolateral elbow instability, synovitis, synovial fold syndrome, frozen shoulder
management
advise person to: apply heat or ice to help relieve pain, rest arm and avoid any aggravating sports or manual work activities for 6 weeks
avoid tasks that involve high force, hand gripping or pinching, or use of high amplitude vibrating handheld tools.
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offer analgesia for symptom relief such as paracetamol or a topical nonsteroidal anti inflammatory drug such as NSAID
advise people using topical ibuprofen gel to avoid smoking and other naked flames as there is a risk of severe burns - or consider prescribing NSAID if symptoms persistent
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when to refer
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surgical treatment such as open or arthroscopic debridement of tendinosis and or release or repair of the damage extensor tendons insertion may be considered
Definition
tennis elbow or lateral epicondylitis describes as tendinosis that affects the common attachment of the tendons of the extensor muscle of the forearm to the lateral epicondyle of the humerus
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characterised by pain in the lateral elbow, pain with wrist extension and reduced grip strength, exacerbated by excessive and repetitive activities, usually affecting the dominant arm.