This is a case history of a 30 year old male with a classical tennis elbow. This is a typical presentation at the practice.
This is a case history of a 30 year old male with a classical tennis elbow Mr.T,visited the Orthocure clinic complaining of pain on the outside of the right elbow around the forearm. Pain started 6 months back after playing badminton as a hobby after along break earlier he use to play regular badminton and tennis, but somehow, he had to discontinue playing. Initially he consulted orthopaedican and took medicines his pain reduced but was not completely relieved. After a month we followed the patient and advised the patient to take physio sessions to get rid of pain. After the initial assessment by the physio, he took 8 sessions within 16 days and was given ultrasound, KT taping, Manual therapy (mulligan glide using the belt) followed by strengthening exercises.
Subjective Examination(Information from patient)
Mr. M reported a pain level of 6/10 and pain, occurs when he lifts laptop bag or anything heavy like racquet of tennis bat, this pain eases off after he takes rest for approx. 1 hr . The patient reports a dull ache going down till mid forearm. He wants to return like to get back to playing. No neck/thoracic pain.Aggravating factors – Gripping, (handbag), elbow flexion or wrist extension. It does not like static positions for long, e.g. 30 min plus.
Easing factors – Rest.
24hrs – Very stiff for 1 hour in the morning. Ache in evening. Depends on activity.
History – Gradual onset over two years, worse in the last three months since playing badminton in summer. No particular reason for starting, no obvious trauma.
Past Medical History – No previous problems in arm. Previous treatment for foot problem in 2000.General health good. No diabetes, epilepsy, high blood pressure, haemophilia, fits. No Rheumatoid Arthritis in family, No allergies. No Pacemaker. No circulatory issues.
Drug history – no medication at present.
Objective Observation – Poor posture, slouched flexed thoracic (mid spine), extended cervical spine (neck). Right forearm/elbow looks wasted in comparison to left (Right Handed). No swelling/colour.
Right elbow Assessment Active movements- (Patient performed) Moving the elbow itself was just a little stiff. Wrist extension (pull back) caused pain at the end of the range. Flexion (wrist down) produced a pull in the forearm muscles. Grip was weak and painful.
Passive movements- (Physiotherapist performed) Elbow movements were full and normal. Bending the wrist with the elbow straight pulled in the spot.
Muscles- Elbow flexion/extension no pain in all ranges. Wrist grip, hand and thumb/finger extension all immediately painful in the outside forearm muscles and tendon and into the lateral epicondyle (bony lump on outside of elbow).
Palpation- Painful, thick lump in the tendon just below lateral epicondyle.
Overview of treatment techniques
1.Elbow mobilisation –MWM’s(Movement with Mobilizations of Superior radio-ulnar joint).
2.Local deep mobilisation of painful area in extensor tendon with extensors on stretch.
3.KT taping -To offload the ECRB at the insertion point.
4.Exercises for loading of muscle and tendon, and neck muscle stretching and self neck mobilisations.
5.Electrotherapy-Ultrasonic therapy with Direct icing to reduce the inflammatory component.
Subsequent treatments will vary according to how the condition is progressing.We feel it is essential to involve the patient in their treatment at all times. Ensuring they understand what is happening to them and what they can do to help themselves.The aim will be to clear all of the symptoms and to return the patient to full activity – including tennis.
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