Assessment and Management of Lateral Elbow Tendinopathy: A Single Case Study
Abstract
Lateral Elbow Tendinopathy (LET) leads to functional disability and is a challenging pathology to manage. The objective of this study is to present how the LET of a male patient was managed by myself in clinical practice. A 55-year-old male hunter developed LET on his left elbow two months prior, after holding a gun for five hours during a hunting trip. The patient complained of lateral elbow and forearm pain, pain that intensified upon palpation, shoulder flexion-extension, wrist dorsiflexion and hand grip. The objective assessment showed clear neurological examination and radial nerve neurodynamic test, restricted shoulder and wrist range of motion (ROM), and positive Maudsley’s and Mill’s special tests. The treatment plan focused on pain control, tendon healing, muscle flexibility, progressive strengthening of wrist and elbow muscles and tolerance increase of the tendon. Different modalities were used, with emphasis given on a combination of different types of exercise. The patient attended 15 sessions in 5 weeks. Considerable progress was made by the end of week 5. From the patient assessment, the derived diagnosis was left LET, and the rehabilitation plan which was evidence-based, proved to be effective.
Keywords
Full Text:
PDFReferences
Ahmed, A., Ibrar, M., Arsh, A., Wali, S., Hayat, S., and Abass, S. (2020). Comparing the effectiveness of mulligan mobilization versus cyriax approach in the management of patients with subacute lateral epicondylitis. Journal of the Pakistan Medical Association, pp.1–11. doi:https://doi.org/10.47391/jpma.399.
Aslam, Z., Zafar, A., Anwar, N., Hayat, M., Arslan, H., & Khalid, K. (2021). Extracorporeal Shock Wave Therapy for Tennis Elbow; A Double Blinded Randomized Clinical Trial Comparing Two Different Energy Levels. Medical Forum Monthly. 32.
Bateman, M., Saunders, B., Littlewood, C. and Hill, J.C. (2021). Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique. BMJ Open, 11(12), p.e053841. doi: https://doi.org/10.1136/bmjopen-2021-053841.
Bateman, M., Saunders, B., Littlewood, C., Davis, D., Beckhelling, J., Cooper, K., Skeggs, A., Foster, N.E., Vicenzino, B. and Hill, J.C. (2022). Comparing an randomize physiotherapy treatment package with usual physiotherapy care for people with tennis elbow — protocol for the OPTimisE pilot and feasibility randomized controlled trial. Pilot and Feasibility Studies, 8(1). Doi: https://doi.org/10.1186/s40814-022-01132-x.
Bateman, M., Whitby, E., Kacha, S. and Salt, E. (2018). Current physiotherapy practice in the management of tennis elbow: A service evaluation. Musculoskeletal Care, 16(2), pp.322–326. Doi: https://doi.org/10.1002/msc.1236.
Choi, W. and Heo, S. (2021). Deep Learning Approaches to Automated Video Classification of Upper Limb Tension Test. Healthcare, 9(11), p.1579. doi: https://doi.org/10.3390/healthcare9111579.
Coombes, B.K., Bisset, L. and Vicenzino, B. (2015). Management of Lateral Elbow Tendinopathy: One Size Does Not Fit All. Journal of Orthopaedic & Sports Physical Therapy, [online] 45(11), pp.938–949. doi:https://doi.org/10.2519/jospt.2015.5841.
Day, J.M., Lucado, A.M. and Uhl, T.L. (2019). A comprehensive rehabilitation program for treating lateral elbow tendinopathy. International Journal of Sports Physical Therapy, 14(5), pp.818–829. doi: https://doi.org/10.26603/ijspt20190818.
De Smedt, T., de Jong, A., Van Leemput, W., Lieven, D. and Van Glabbeek, F. (2007). Lateral epicondylitis in tennis: update on aetiology, biomechanics, and treatment. British Journal of Sports Medicine, 41(11), pp.816–819. Doi: https://doi.org/10.1136/bjsm.2007.036723.
Fousekis, Κ., 2015. Εφαρμοσμένη Αθλητική Φυσικοθεραπεία. 1st ed. Broken Hill Publishers.
Gupta, S., Bawa, Sukhjeet., Abhishek. (2017). Comparative Study: Between PRP Injection VS. Physiotherapy in treatment of Tennis Elbow. International Journal of Scientific Research, 6(6), pp. 124-126.
Hattam, P. and Smeatham, A. (2020). Handbook of Special Tests in Musculoskeletal Examination E-Book. Elsevier Health Sciences.
Kheiran, A., Pandey, A. and Pandey, R. (2021). Common tendinopathies around the elbow; what does current evidence say? Journal of Clinical Orthopaedics and Trauma, 19, pp.216–223. doi: https://doi.org/10.1016/j.jcot.2021.05.021.
Koulidis, K., Veremis, Y., Anderson, C. and Heneghan, N.R. (2019). Diagnostic accuracy of upper limb neurodynamic tests for the assessment of peripheral neuropathic pain: A systematic review. Musculoskeletal Science and Practice, 40, pp.21–33. Doi: https://doi.org/10.1016/j.msksp.2019.01.001.
Landesa-Piñeiro, L. and Leirós-Rodríguez, R. (2021). Physiotherapy treatment of lateral epicondylitis: A systematic review. Journal of Back and Musculoskeletal Rehabilitation, 35(3), pp.1–15. Doi: https://doi.org/10.3233/bmr-210053.
Levina, Y. and Dantuluri, P.K. (2021). Radial Tunnel Syndrome. Current Reviews in Musculoskeletal Medicine, 14(3), pp.205–213. Doi: https://doi.org/10.1007/s12178-021-09703-w.
Lucado, A.M., Dale, R.B., Vincent, J. and Day, J.M. (2019). Do joint mobilizations assist in the recovery of lateral elbow tendinopathy? A systematic review and meta-analysis. Journal of Hand Therapy, 32(2), pp.262-276.e1. doi:https://doi.org/10.1016/j.jht.2018.01.010.
Maurya, B. and Mhase, S. (2018). Effect of Cyriax physiotherapy on pain and functional disability in badminton players with tennis elbow. International Journal of Academic Research and Development, 3(3), pp. 136-139.
Ortega-Castillo, M., Cuesta-Vargas, A., Luque-Teba, A. and Trinidad-Fernández, M. (2022). The role of progressive, therapeutic exercise in the management of upper limb tendinopathies: A systematic review and meta-analysis. Musculoskeletal Science and Practice, [online] 62, p.102645. doi:https://doi.org/10.1016/j.msksp.2022.102645.
Paraskevopoulos E, Plakoutsis G, Papandreou M. A Pilot Test of the Measures of the Greek Version of Upper Extremity Functional Index in Patients with Lateral Elbow Tendinopathy. Medical Sciences. 2023; 11(3):45. https://doi.org/10.3390/medsci11030045.
Paraskevopoulos E, Christakou A, Karanasios S, Louka AP, Pamboris GM, Papandreou M. Translation, Adaptation and Validation of the Greek Version of the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score in Greek Overhead Athletes. Journal of Functional Morphology and Kinesiology. 2024; 9(1):49. https://doi.org/10.3390/jfmk9010049.
Sarin, A., s, J. and Michael (2018). To Study the Effectiveness of Cyriax Manual Therapy Vs. Muscle Energy Technique in Subjects with Tennis Elbow on Pain, Grip Strength and Functional Disability. Journal of Physiotherapy & Physical Rehabilitation, 03(03). doi: https://doi.org/10.4172/2573-0312.1000159.
Singh, A., Wadhwa, K., Kumar, S., Fahim, T., and Mahajan, R. (2022). Comparison of effectiveness of Cyriax physiotherapy and mobilization with movement technique in patients with tennis elbow. International Journal of Physical Education, Sports and Health, 9(2), pp. 147-150.
Stasinopoulos, D. (2016). Lateral elbow tendinopathy: Evidence of physiotherapy management. World Journal of Orthopedics, 7(8), p.463. doi: https://doi.org/10.5312/wjo.v7.i8.463.
Stasinopoulos, D. (2022). Isometric Exercise for the Management of Lateral Elbow Tendinopathy. Journal of Clinical Medicine, 12(1), p.94. doi: https://doi.org/10.3390/jcm12010094.
Stasinopoulos, D. and Stasinopoulos, I. (2017). Comparison of effects of eccentric training, eccentric-concentric training, and eccentric-concentric training combined with isometric contraction in the treatment of lateral elbow tendinopathy. Journal of Hand Therapy, 30(1), pp.13–19. doi: https://doi.org/10.1016/j.jht.2016.09.001.
Yan, C., Xiong, Y., Chen, L., Endo, Y., Hu, L., Liu, M., Liu, J., Xue, H., Abududilibaier, A., Mi, B. and Liu, G. (2019). A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research, 14(1). Doi: https://doi.org/10.1186/s13018-019-1290-y.
DOI: http://dx.doi.org/10.18415/ijmmu.v11i9.6205
Refbacks
- There are currently no refbacks.
Copyright (c) 2024 International Journal of Multicultural and Multireligious Understanding
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
https://ijmmu.com
editor@ijmmu.com
facebook.com/ijmmu
Copyright © 2014-2018 IJMMU. All rights reserved.