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Tennis Elbow Handout 503-293-0161
® ® sports INjury medicine department 9250 SW Hall Blvd., Tigard, OR 97223 Tennis Elbow Handout 503-293-0161 WHAT IS IT? Lateral Epicondylitis Tennis elbow, also known as lateral epicondylitis, is one of the most common painful conditions of the elbow. Inflammation and (Tennis Elbow) pain occur on and around the outer bony bump of the elbow where the muscles and tendons attach to the bone. These structures are responsible for lifting your wrist up so this condition can occur with many activities, not just tennis. Humerus (arm bone) Area of pain Tendon lateral epicondyle WHAT ARE THE SYMPTOMS? Most commonly you will have pain & tenderness on the outer side of the elbow and this pain may even travel down the forearm. Often there is pain and/or weakness with gripping and lifting activities. You may also experience difficulty with twisting activities during sports or even opening the lid of a jar. WHY DOES IT HURT? It hurts because you are putting tension on a place where the tissue is weakened, which is usually due to a degenerative process that seems to take a long time for your body to recognize and heal. WHY DO I HAVE IT? This is a common problem and unfortunately we don’t know why some people get this condition and others do not. Surprisingly, it is not at all clear that it comes from overuse or something that you did “wrong”. There is no doubt that if you do have tennis elbow, it will bother you more to do certain things, but that does not necessarily mean it was caused by those activities. -
Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 19 and Other Musculoskeletal Conditions
Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 19 and Other Musculoskeletal Conditions Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association. Title: Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions Professional Institutional Original Effective Date: July 11, 2001 Original Effective Date: July 1, 2005 Revision Date(s): November 5, 2001; Revision Date(s): December 15, 2005; June 14, 2002; June 13, 2003; October 26, 2012; May 7, 2013; January 28, 2004; June 10, 2004; April 15, 2014 April 21, 2005; December 15, 2005; October 26, 2012; May 7, 2013; April 15, 2014 Current Effective Date: April 15, 2014 Current Effective Date: April 15, 2014 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. If your patient is covered under a different Blue Cross and Blue Shield plan, please refer to the Medical Policies of that plan. -
Pathologies of the Elbow
Elbow Lateral Epicondylitis (tennis elbow) PathologyPathology 3030 –– 5050 yearsyears oldold RepetitiveRepetitive micro-traumamicro-trauma ChronicChronic teartear inin thethe originorigin ofof thethe extensorextensor carpicarpi radialisradialis brevisbrevis Lateral Epicondylitis (tennis elbow) MechanismMechanism ofof InjuryInjury OveruseOveruse syndromesyndrome causedcaused byby repeatedrepeated forcefulforceful wristwrist andand fingerfinger movementsmovements TennisTennis playersplayers ProlongedProlonged andand rapidrapid activitiesactivities Lateral Epicondylitis (tennis elbow) ClinicalClinical SignsSigns andand SymptomsSymptoms IncreasedIncreased painpain aroundaround laterallateral epicondyleepicondyle TendernessTenderness inin palpationpalpation CETCET TestsTests AROM;AROM; PROMPROM ResistedResisted teststests LidocaineLidocaine Treatment of Tennis Elbow Medial Epicondylitis (golfer’s elbow) PathologyPathology 3030 -- 5050 yearsyears oldold RepetitiveRepetitive micromicro traumatrauma toto commoncommon flexorflexor tendontendon Medial Epicondylitis (golfer’s elbow) MechanismsMechanisms ofof injuryinjury ThrowingThrowing aa baseballbaseball RacquetballRacquetball oror tennistennis SwimmingSwimming backstrokebackstroke HittingHitting aa golfgolf ballball Medial Epicondylitis (golfer’s elbow) ClinicalClinical signssigns andand symptomssymptoms IncreasedIncreased painpain overover medialmedial epicondyleepicondyle TendernessTenderness onon palpationpalpation CFTCFT TestsTests AROM;AROM; PROMPROM ResistedResisted -
A Patient's Guide to Tennis Elbow (Lateral Epicondylitis)
Dr. Edward Kelly www.edwardkellymd.com A Patient’s Guide To Tennis Elbow (Lateral Epicondylitis) WHAT IS TENNIS ELBOW? Tennis elbow is breakdown and degeneration of tendons which attach to the outside (or lateral side) of the elbow. The muscles which work the hand and wrist begin as tendons which attach on a bony prominence on the lateral side of the elbow. This prominence is the lateral epicondyle of the humerus, so tennis elbow is degeneration of the tendons that attach to the lateral epicondyle (and so it is also called “lateral epicondylitis”). The pain can radiate into the forearm and occasionally into the hand. WHAT CAUSES IT? Tennis elbow typically is caused by repetitive gripping and grasping activities or occasionally from direct trauma to the outside of the elbow. Examples include when someone increases the amount of squeezing or gripping they perform, such as trimming the hedge or playing more tennis than usual. Once the tendons get injured it can be difficult to eradicate because those tendons are used every time the hand grips or squeezes. IS IT A SERIOUS CONDITION? Tennis elbow can be a painful and debilitating problem but does not lead to serious problems, like arthritis. However, x-rays or an ultrasound scan may be necessary in some cases to evaluate the elbow joint. An examination by a physician in the office will confirm the diagnosis of lateral epicondylitis. Lateral epicondylitis is the type of condition that will never get so bad that treatment cannot be performed. In many cases, it will resolve over time with non-operative treatments. -
Musculoskeletal Ultrasound Technical Guidelines II. Elbow
European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines II. Elbow Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy Elbow Note The systematic scanning technique described below is only theoretical, considering the fact that the examination of the elbow is, for the most, focused to one quadrant only of the joint based on clinical findings. 1 ANTERIOR ELBOW For examination of the anterior elbow, the patient is seated facing the examiner with the elbow in an extension position over the table. The patient is asked to extend the elbow and supinate the fore- arm. A slight bending of the patient’s body toward the examined side makes full supination and as- sessment of the anterior compartment easier. Full elbow extension can be obtained by placing a pillow under the joint. Transverse US images are first obtained by sweeping the probe from approximately 5cm above to 5cm below the trochlea-ulna joint, a Pr perpendicular to the humeral shaft. Cranial US images of the supracondylar region reveal the superficial biceps and the deep brachialis mu- Br scles. Alongside and medial to these muscles, follow the brachial artery and the median nerve: * the nerve lies medially to the artery. * Legend: a, brachial artery; arrow, median nerve; arrowheads, distal biceps tendon; asterisks, articular cartilage of the Humerus humeral trochlea; Br, brachialis muscle; Pr, pronator muscle 2 distal biceps tendon: technique The distal biceps tendon is examined while keeping the patient’s forearm in maximal supination to bring the tendon insertion on the radial tuberosity into view. -
Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions
Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 62 and Other Musculoskeletal Conditions Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions Professional Institutional Original Effective Date: July 11, 2001 Original Effective Date: July 1, 2005 Revision Date(s): November 5, 2001; Revision Date(s): December 15, 2005; June 14, 2002; June 13, 2003; October 26, 2012; May 7, 2013; January 28, 2004; June 10, 2004; April 15, 2014; April 14, 2015; April 21, 2005; December 15, 2005; August 4, 2016; January 1, 2017; October 26, 2012; May 7, 2013; August 10, 2017; August 1, 2018; April 15, 2014; April 14, 2015; July 17, 2019, March 11, 2021 August 4, 2016; January 1, 2017; August 10, 2017; August 1, 2018; July 17, 2019, March 11, 2021 Current Effective Date: August 10, 2017 Current Effective Date: August 10, 2017 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. -
Hand, Elbow, Wrist Pain
Physical and Sports Therapy Hand, Elbow, Wrist Pain The hand is a wondrously complex structure of tiny bones, muscles, ligaments, and tendons which work together to perform tasks. The wrist and elbow are stabilizing joints that support the steady use of the hand and provide attachment points for the muscles that control the hand and wrist. All three of these areas are prone to injury from overuse or trauma. Their complexity requires the skills of an expert for proper rehabilitation from injury. Some Hand, Wrist, and Elbow Issues Include: Tennis/Golfer’s Elbow: Tendonitis, or inflammation of the tendons, at the muscular attachments near the elbow. Symptoms typically include tenderness on the sides of the elbow, which increase with use of the wrist and hand, such as shaking hands or picking up a gallon of milk. Tendonitis responds well to therapy, using eccentric exercise, stretching, and various manual therapy techniques. Carpal Tunnel Syndrome: Compression of the Median Nerve at the hand/base of your wrist. Symptoms include pain, numbness, and tingling of the first three fingers. The condition is well-known for waking people at night. Research supports the use of therapy, particularly in the early phase, for alleviation of the compression through stretching and activity modification. Research indicates that the longer symptoms are present before initiating treatment, the worse the outcome for therapy and surgical intervention due to underlying physiological changes of the nerve. What can Physical or Occupational therapy do for Hand, Wrist, or Elbow pain? Hand, wrist, and elbow injuries are commonly caused by trauma, such as a fall or overuse. -
Hughston Health Alert US POSTAGE PAID the Hughston Foundation, Inc
HughstonHughston HealthHealth AlertAlert 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31908-9517 • www.hughston.com/hha VOLUME 24, NUMBER 3 - SUMMER 2012 Normal knee anatomy Fig. 1. Anterior knee Inside... pain can be caused by patellofemoral syndrome, • Orthopaedic Components: Quadriceps often called “cyclist’s knee,” muscle What makes a total knee implant? or by patellar tendinitis. • Tennis and Back Pain • Glucosamine and Chondroitin Femur • New Heat Policies - Summer 2012 Patella (kneecap) Imbalances in strength and • Hughston Clinic tone of the lower body Patellar can result in excessive tendon Fibula compressive forces Tibia across the joint. (shinbone) Cycling Overuse Injuries of the Knee Patellofemoral syndrome Compression and shearing across the cartilage of the Quadriceps The economy and higher gas prices are patella can lead to loss of muscle straining wallets and making cycling a more cartilage and the beginning attractive mode of transportation. Health of arthritis. Calf enthusiasts use cycling as a low-impact muscles exercise to improve overall fitness and Patella minimize knee pain. Cities throughout the (kneecap) country are turning old, abandoned railroad Damaged lines into miles of beautiful biking trails and cartilage Femur adding bike lanes to existing roads. In essence, Trochlear cycling is becoming one of the nation’s most groove popular pastimes. Patellar tendinitis Cycling has many health benefits; you Front Quadriceps Cross section of can tone your muscles, improve your view muscle a bent knee cardiovascular fitness, and burn as many as of bent 300 calories an hour during a steady ride. knee People often turn to cycling as a form of Fibula Femur exercise and enjoyment because it is a low- Tibia (thighbone) impact exercise that is easy on the knees. -
Download Versus Arthritis
Elbow pain Elbow pain information booklet Contents How does the elbow work? 4 What causes elbow pain and stiffness? 6 Should I see a healthcare professional? 8 What can I do to help myself? 9 How are elbow problems diagnosed? 12 What treatments are there for elbow pain? 14 Specific elbow conditions 18 Glossary 26 Research and new developments 27 Keeping active with elbow pain 28 Where can I find out more? 32 We’re the 10 million people living with arthritis. We’re the carers, researchers, health professionals, friends and parents all united in Talk to us 33 our ambition to ensure that one day, no one will have to live with the pain, fatigue and isolation that arthritis causes. We understand that every day is different. We know that what works for one person may not help someone else. Our information is a collaboration of experiences, research and facts. We aim to give you everything you need to know about your condition, the treatments available and the many options you can try, so you can make the best and most informed choices for your lifestyle. We’re always happy to hear from you whether it’s with feedback on our information, to share your story, or just to find out more about the work of Versus Arthritis. Contact us at [email protected] Words shown are explained in the glossary on p.26. Registered office: Versus Arthritis, Copeman House, St Mary’s Gate, Chesterfield S41 7TD in bold Registered Charity England and Wales No. 207711, Scotland No. SC041156. -
Stretching and Positioning Regime for Upper Limb
Information for patients and visitors Stretching and Positioning Regime for Upper Limb Physiotherapy Department This leaflet has been designed to remind you of the exercises you Community & Therapy Services have been taught, the correct techniques and who to contact with any queries. For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients and visitors Muscle Tone Muscle tone is an unconscious low level contraction of your muscles while they are at rest. The purpose of this is to keep your muscles primed and ready to generate movement. Several neurological causes may change a person’s muscle tone to increase or decrease resulting in a lack of movement. Over time, a lack of movement can cause stiffness, pain, and spasticity. In severe cases this may also lead to contractures. Spasticity Spasticity can be defined as a tightening or stiffness of the muscle due to increased muscle tone. It can interfere with normal functioning. It can also greatly increase fatigue. However, exercise, properly done, is vital in managing spasticity. The following tips may prove helpful: • Avoid positions that make the spasticity worse • Daily stretching of muscles to their full length will help to manage the tightness of spasticity, and allow for optimal movement • Moving a tight muscle to a new position may result in an increase in spasticity. If this happens, allow a few minutes for the muscles to relax • When exercising, try to keep head straight • Sudden changes in spasticity may -
Bone Limb Upper
Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior -
Overuse Injuries in Elite Athletes
ATHLETES: OVERUSE MRI of Overuse INJURIES VERY COMMON Injury in the Elite Athlete • Muscle William B. Morrison, M.D. Associate Professor of • Joints Radiology Thomas Jefferson • Tendon University Hospital Philadelphia, PA USA • Ligament • Bone [email protected] How is this Relevant to My Practice? • High performance athletes get similar injuries as ‘regular’ people… but: – More of them, & at a younger age MUSCLE / SOFT TISSUE – More commonly imaged – Secondary gain involved INJURY • All the cases here are high performance athletes – but most injuries are conventional • Exceptions – Some weird sport-specific patterns of stress and other injuries – Acute injuries as opposed to overuse •Overuse –DOMS Muscle Injury Delayed Onset Muscle • Acute injury Soreness (DOMS) – Tendon – Myotendinous junction • All athletes are susceptible if they – Muscle belly change training regimen • Athletes tend to work out intensely – leads to muscle injury • Rarely imaged (“no pain no gain”) – Weightlifting / aerobic exercise – 24hr later – soreness – Can be severe, even look like a tear 1 Acute Muscle Injury • Direct → muscle belly, esp quadriceps T2 – esp rugby, football • Indirect → myotendinous junction – eccentric contraction – sudden acceleration / DOMS: Lateral gastrocnemius deceleration Finding can be subtle, even with T2 and fat sat Professional football player Acute Injury – T1 Quadriceps hematoma Muscle belly injury Myotendinous Unit Hit with helmet • Myotendinous Junction – ‘weak link’ of normal myotendinous complex T2 – Common place for injury – Most common mechanism: eccentric contraction (muscle lengthens and contracts at the same High time) T1 = blood Gastrocnemius tear: Grade 1 Muscle Strain “V” sign • Ill-defined edema T2 T1 STIR Weishaupt D, JCAT 2001; 25:677 2 Gd Gd can help identify Grade 2 Muscle Strain subtle muscle injury AKA “Partial Tear” STIR Professional baseball player Grade 1 strain Sartorius m.