TENNIS ELBOW

Tennis Elbow, also known as lateral epicondylitis is an extensor tendinopathy which involves ECRB tendon. Its an overuse injury resulting from repeated use of wrist extensors and is commonly experienced by plumbers, gardeners, cleaners, carpenters, mechanics, bowlers, baseball players and tennis players.

The symptoms usually involves pain radiating from the lateral aspect of the elbow to the forearm and back of the hand when grasping or twisting or lifting heavy objects.

Mill's and Cozen's tests are the special tests used to diagnose the tennis elbow in which when the long extensors of wrist are stressed, it causes pain on the lateral epicondyle of the elbow which is the origin of the common extensors.

Physical Therapy Treatment goals
a) Pain reduction- Cold therapy in the form of ice packs (for approx. 15Mins, 2 times a day) Therapeutic Ultrasound, Iontophoresis using NSAIDS or corticosteroids.

b) Activity modification- Avoid pain aggravating activities, Change in technique or ergonomic changes at work station to reduce load on wrist extensors.

c) Counterforce bracing- To reduce stress on the common extensor origin. Its worn 10cm distal to the elbow joint on the proximal forearm.

d) Exercise therapy- To stretch and strengthen the muscles of the forearm and to maintain the flexiblity of the muscles of the forearm.
1. Gentle streching exercises of wrist flexion, extension and rotation with elbow in extension. Avoid vigrous stretching and stretching to the point of pain. Maintain the stretch for 15- 20 seconds.
2. Strengthening of wrist flexors, extensors, ulnar and radial deviators alongwith supinators and pronators with elbow flexed and forearm supported using weight cuffs or dumbbells. These exercises can be started in gravity eliminated plane and later on can be progressed to against gravity activities.
3. Isometric finger extension(using a rubber band around fingers) and flexion exercises(by squeezing a tennis ball).
4. In later stages, focus should be on eccentric contractions of the wrist extensors.


Other treatment options (for chronic cases)
Steroid injections
Surgery- If 6 months of conservative treatment fails or at the discretion of the orthopaedician.

Shoulder impingement syndrome and Physical Therapy

Shoulder impingement results from the compression of the rotator cuff muscles under the coracoacromial arch.
Inflammation and pain occurs and is aggravated by the shoulder and arm movements.Pain is felt on antero lateral aspect of shoulder radiating down to mid arm at times.
It can be confirmed with Hawkins-Kennedy impingement test and Neer's impingement test.

ETIOLOGY of shoulder impingement syndrome is multifactorial-

1. Acute trauma: fall on to the shoulder or direct blow on the shoulder.

2. Chronic injury from:
a) Repeated overhead activity like throwing, lifting and catching.
b) Improper postural habits leading to muscle imbalances between deltoid and infraspinatus, teres minor, subscapularis or between supraspinatus and gravity. As a result one group of muscles become tight and other gets stretched and become weak.Loss of rotator cuff strength causes superior migration of humerus resulting in impingement.

3.Outlet impingement due to subacromial osteophytes, hooked or beaked acromion shape, thickened or calcified coracoacromial ligament.


TREATMENT GOALS

1-Decrease the inflammation

*Cryotherapy-Use ice packs for a maximum of 15 minutes, 3 times a day
*Anti inflammatory medication
*Relative rest-Avoiding aggravating and loading activities like overhead reaching and lifting heavy weights in order to prevent further injury to the rotator cuff.

2-Improve posture and shoulder ROM

*Gentle stretching exercises and ROM
-Downward and backward pulling of both the arms with the hands clasped behind the back
-Scapular retraction exercises
-Codman pendular exercises
-Horizontal adduction stretch
-Triceps stretching
-Corner stretch-to stretch the front of the shoulder and the pectorals muscles by pushing against a wall in the corner of the room.
-Biceps stretch

* Sit with back fully supported and work with shoulders being close to the body.

3-Strengthen the rotator cuff muscles and scapular stabilizers.

*Bilateral shoulder extension exercises in prone or standing position.
*Resisted shoulder external and internal rotation in the gravity eliminated plane.
*Supraspinatus strenthening by resisting shoulder abduction in empty can position of the hand.
*Bilateral shoulder abduction in prone
*Supine press
*Biceps curls