SlideShare una empresa de Scribd logo
1 de 28
Descargar para leer sin conexión
TENNIS
ELBOW
Subin S
2k14 MBBS
JIPMER
What is tennis elbow?
• Tennis elbow/lateral epicondylitis is the tendinopathy of the
common extensor-supinator tendon.
• Lateral periepicondylar pain and tenderness that is
exacerbated by forceful repetitive wrist extension.
Tennis elbow
History
• In 1883, H.P.Major noted that this condition commonly affected
tennis players, the complaint became popularly known as
‘tennis elbow’(Nirschl 1974).
• Seen in 13% of elite tennis players and 50% of non elite players.
• But 95% of cases occur in those who do not play tennis and are
associated with manual occupations.
Pathology
• Degenerative microtears in common extensor-supinator tendon
due to repetitive mechanical overload.
• The tendinous origin of Extensor carpi radialis brevis most
commonly affected.
• Microscopic feature of surgical specimen:
 Hyaline degeneration
 Fibroblastic and vascular proliferation- angiofibroblastic
hyperplasia
 Microscopic calcification
Tennis elbow
Etiology
• Tennis players: due to faulty playing techniques mostly a late
mechanically poor backhand.
• Non tennis players:
 95% of cases seen
 Housewives, carpenters, miners, drill workers, other sports.
 Use of computer
Tennis elbow
Clinical features
• Usually an Active individual of 30 or 40 years.
• Pain and tenderness over lateral epicondyle of elbow.
• Acute or insidious onset of pain.
• History of over use, involving forceful gripping, repetitive flexion-
extension at wrist or pronation-supination activity.
• Pain aggravated by movements like pouring out tea, turning stiff door
handle, shaking hands, lifting weights,etc.
• Elbow looks normal and flexion and extension are full and normal.
Physical Examination
• Localised tenderness at or just below the lateral epicondyle
• Cozen’s test: painful resisted extension of the wrist with elbow in full
extension elicits pain at the lateral aspect of elbow
• Mill’s test: Elbow held in extension ,passive wrist flexion and
pronation produces pain.
• Maudsley’s test: examiner resist the extension of third digit of hand ,
stressing the extensor digitorum muscle and tendon. A positive test is
indicated by pain over lateral epicondyle.
Cozen’s test:
Mill’s test
Maudsley’s test
Differential diagnosis
• Radial tunnel syndrome: posterior interosseous nerve
entrapment between the fibres of supinator muscle. Clinically
pain will increase with resisted supination. Pain is located 3-
4cm distal to lateral epicondyle.
• Osteochondritis dissecans of the elbow: patient may
complaint of snapping or locking. Maximum tenderness found
posterior to lateral epicondyle.
Imaging
• Not routinely performed
• Diagnostic ultrasound features include:
 In active severe disease- neovascularisation
 Local fluid collection
 In chronic cases- dystrophic calcification at tendon insertion
Conservative Treatment
• 90% of ‘tennis elbow’ will resolve spontaneously within 6-12 months.
• First step is to identify and restriction or modification of the activities which
cause pain.
• In acute stages use of ice pack, use of NSAIDS(preferably topical) can be
useful.
• Compression strap applied distal to bulk of extensor mass(to reduce
maximum contraction) is helpful. It is used only during aggravating activity.
• Injection of tender area with corticosteroids and local anaesthetic relieves
pain but is not curative.
• Physical therapy: ultrasound therapy, remedial exercises may be effective in
long term
Compression strap
Tennis elbow
Ultrasound therapy
Operative treatment
• Indicated in sufficiently persistent or recurrent cases usually after 6-
12 months of failed conservative management.
Options :
I. Open debridement of the diseased tissue of the ECRB
II. Percutaneous release
III. Arthroscopic debridement
Open debridement
Percutaneous debridement
Arthroscopic debridement
Newer experimental treatments
• Injections : autologous blood, platelet rich plasma , botulinum toxin
• Laser therapy
• Extra corporeal shock wave therapy
Extra corporeal shock wave therapy
In NEWS
Bibliography
• Apley’s system of orthopaedics and fracture, 9th edition
• Oxford Sports injuries by Michael Hutson and Cathy Speed
• Textbook of orthopaedics by John Ebnezar, 4th edition
• Essential handbook of practical orthopaedic examination by Kaushik
Banerjee, 4th edition
• Essential orthopaedics by Maheshwari, 5th edition
THANK YOU

Más contenido relacionado

La actualidad más candente

La actualidad más candente (20)

Tennis elbow(le)
Tennis elbow(le)Tennis elbow(le)
Tennis elbow(le)
 
Frozen shoulder
Frozen shoulderFrozen shoulder
Frozen shoulder
 
Shoulder impingement syndrome
Shoulder impingement syndromeShoulder impingement syndrome
Shoulder impingement syndrome
 
Coccydynia
Coccydynia Coccydynia
Coccydynia
 
Trigger finger final
Trigger finger finalTrigger finger final
Trigger finger final
 
Periarthritis shoulder
Periarthritis shoulderPeriarthritis shoulder
Periarthritis shoulder
 
Plantar fascitis final
Plantar fascitis finalPlantar fascitis final
Plantar fascitis final
 
Frozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy ManagementFrozen Shoulder Physiotherapy Management
Frozen Shoulder Physiotherapy Management
 
Heel spur
Heel spurHeel spur
Heel spur
 
Ankle Sprains
Ankle SprainsAnkle Sprains
Ankle Sprains
 
Piriformis syndrome
Piriformis syndromePiriformis syndrome
Piriformis syndrome
 
Osteoarthritis knee
Osteoarthritis  kneeOsteoarthritis  knee
Osteoarthritis knee
 
Volkmann's ischaemic contracture
Volkmann's ischaemic contractureVolkmann's ischaemic contracture
Volkmann's ischaemic contracture
 
Arthrodesis
ArthrodesisArthrodesis
Arthrodesis
 
De quervain's
De quervain'sDe quervain's
De quervain's
 
Meniscus injury
Meniscus injuryMeniscus injury
Meniscus injury
 
Myositis ossificans
Myositis ossificansMyositis ossificans
Myositis ossificans
 
Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013Supraspinatus tendinitis 30may2013
Supraspinatus tendinitis 30may2013
 
Periarthritis shoulder & painful arc
Periarthritis shoulder & painful arcPeriarthritis shoulder & painful arc
Periarthritis shoulder & painful arc
 
Colles' fracture & physiotherapy management
Colles' fracture & physiotherapy management Colles' fracture & physiotherapy management
Colles' fracture & physiotherapy management
 

Similar a Tennis elbow

Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptx
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptxUnit 1_ Orthopedic Nursing^J Educational Platform copy.pptx
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptxRawalRafiqLeghari
 
Misc. affections of soft tissue
Misc. affections of soft tissueMisc. affections of soft tissue
Misc. affections of soft tissueDr. Anshu Sharma
 
Tenis elbow
Tenis elbowTenis elbow
Tenis elbowmamunur1
 
compartment syndrome.pptx
compartment syndrome.pptxcompartment syndrome.pptx
compartment syndrome.pptxKarthik MV
 
carpal tunnel syndrome and dupuytren disease
carpal tunnel syndrome and dupuytren diseasecarpal tunnel syndrome and dupuytren disease
carpal tunnel syndrome and dupuytren diseaserohit raj
 
Carpel tunnel syndrome
Carpel tunnel syndromeCarpel tunnel syndrome
Carpel tunnel syndromeShruti Shirke
 
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)Tendinopathies(tennis,golfers,dequervains,intersection syndrome)
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)Prasanthmuddada
 
Spine and extermity injury.pptx
Spine and extermity injury.pptxSpine and extermity injury.pptx
Spine and extermity injury.pptxkalilinux24
 
Surgical management of tennis elbow
Surgical management of tennis elbowSurgical management of tennis elbow
Surgical management of tennis elbowAtanu Kayal
 
Out comes of lower level laser vs ultrasonic
Out comes of lower level laser vs ultrasonicOut comes of lower level laser vs ultrasonic
Out comes of lower level laser vs ultrasonicDR.SUNIL KUMAR
 
Compartment syndromes
Compartment syndromesCompartment syndromes
Compartment syndromesOladele Situ
 

Similar a Tennis elbow (20)

Tennis elbow
Tennis elbowTennis elbow
Tennis elbow
 
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptx
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptxUnit 1_ Orthopedic Nursing^J Educational Platform copy.pptx
Unit 1_ Orthopedic Nursing^J Educational Platform copy.pptx
 
Misc. affections of soft tissue
Misc. affections of soft tissueMisc. affections of soft tissue
Misc. affections of soft tissue
 
Tenis elbow
Tenis elbowTenis elbow
Tenis elbow
 
Lateral epicondylitis
Lateral epicondylitisLateral epicondylitis
Lateral epicondylitis
 
compartment syndrome.pptx
compartment syndrome.pptxcompartment syndrome.pptx
compartment syndrome.pptx
 
carpal tunnel syndrome and dupuytren disease
carpal tunnel syndrome and dupuytren diseasecarpal tunnel syndrome and dupuytren disease
carpal tunnel syndrome and dupuytren disease
 
Elbow Pain
Elbow PainElbow Pain
Elbow Pain
 
Carpel tunnel syndrome
Carpel tunnel syndromeCarpel tunnel syndrome
Carpel tunnel syndrome
 
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)Tendinopathies(tennis,golfers,dequervains,intersection syndrome)
Tendinopathies(tennis,golfers,dequervains,intersection syndrome)
 
Spine and extermity injury.pptx
Spine and extermity injury.pptxSpine and extermity injury.pptx
Spine and extermity injury.pptx
 
Surgical management of tennis elbow
Surgical management of tennis elbowSurgical management of tennis elbow
Surgical management of tennis elbow
 
Soft tissue lesion .prof g s patnaik
Soft tissue lesion .prof g s patnaikSoft tissue lesion .prof g s patnaik
Soft tissue lesion .prof g s patnaik
 
Out comes of lower level laser vs ultrasonic
Out comes of lower level laser vs ultrasonicOut comes of lower level laser vs ultrasonic
Out comes of lower level laser vs ultrasonic
 
TENNIS ELBOW
TENNIS ELBOWTENNIS ELBOW
TENNIS ELBOW
 
Thoracic outlet syndrome.
Thoracic outlet syndrome.Thoracic outlet syndrome.
Thoracic outlet syndrome.
 
Compartment syndromes
Compartment syndromesCompartment syndromes
Compartment syndromes
 
Amputations
Amputations Amputations
Amputations
 
De quervain syndrome
De quervain syndromeDe quervain syndrome
De quervain syndrome
 
Rheumatoid arthitis
Rheumatoid arthitisRheumatoid arthitis
Rheumatoid arthitis
 

Último

Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxNaveenkumar267201
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .Mohamed Rizk Khodair
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdfHongBiThi1
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthGokuldas Hospital
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfDolisha Warbi
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfrg0000009
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024EwoutSteyerberg1
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdfHongBiThi1
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...Sujoy Dasgupta
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
AI in Action: Elevating Patient Insights
AI in Action: Elevating Patient InsightsAI in Action: Elevating Patient Insights
AI in Action: Elevating Patient InsightsEmily Kunka, MS, CCRP
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu Medical University
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfHongBiThi1
 

Último (20)

Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptxBreast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
Breast cancer -ONCO IN MEDICAL AND SURGICAL NURSING.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
Neurological history taking (2024) .
Neurological  history  taking  (2024)  .Neurological  history  taking  (2024)  .
Neurological history taking (2024) .
 
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdfSGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA    .pdf
SGK NGẠT NƯỚC ĐHYHN RẤT LÀ HAY NHA .pdf
 
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint HealthArthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
Arthroscopic Surgery in Indore : A Minimally Invasive Guide to Joint Health
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdfCONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
CONNECTIVE TISSUE (ANATOMY AND PHYSIOLOGY).pdf
 
Cure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdfCure of patients which terminally ill.pdf
Cure of patients which terminally ill.pdf
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024Trustworthiness of AI based predictions Aachen 2024
Trustworthiness of AI based predictions Aachen 2024
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdfSGK ĐIỆN GIẬT ĐHYHN        RẤT LÀ HAY TUYỆT VỜI.pdf
SGK ĐIỆN GIẬT ĐHYHN RẤT LÀ HAY TUYỆT VỜI.pdf
 
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio..."Radical excision of DIE in subferile women with deep infiltrating endometrio...
"Radical excision of DIE in subferile women with deep infiltrating endometrio...
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
AI in Action: Elevating Patient Insights
AI in Action: Elevating Patient InsightsAI in Action: Elevating Patient Insights
AI in Action: Elevating Patient Insights
 
Mental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil ThirusanguMental health Team. Dr Senthil Thirusangu
Mental health Team. Dr Senthil Thirusangu
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdfSGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
SGK RỐI LOẠN TOAN KIỀM ĐHYHN RẤT HAY VÀ ĐẶC SẮC.pdf
 

Tennis elbow

  • 2. What is tennis elbow? • Tennis elbow/lateral epicondylitis is the tendinopathy of the common extensor-supinator tendon. • Lateral periepicondylar pain and tenderness that is exacerbated by forceful repetitive wrist extension.
  • 4. History • In 1883, H.P.Major noted that this condition commonly affected tennis players, the complaint became popularly known as ‘tennis elbow’(Nirschl 1974). • Seen in 13% of elite tennis players and 50% of non elite players. • But 95% of cases occur in those who do not play tennis and are associated with manual occupations.
  • 5. Pathology • Degenerative microtears in common extensor-supinator tendon due to repetitive mechanical overload. • The tendinous origin of Extensor carpi radialis brevis most commonly affected. • Microscopic feature of surgical specimen:  Hyaline degeneration  Fibroblastic and vascular proliferation- angiofibroblastic hyperplasia  Microscopic calcification
  • 7. Etiology • Tennis players: due to faulty playing techniques mostly a late mechanically poor backhand. • Non tennis players:  95% of cases seen  Housewives, carpenters, miners, drill workers, other sports.  Use of computer
  • 9. Clinical features • Usually an Active individual of 30 or 40 years. • Pain and tenderness over lateral epicondyle of elbow. • Acute or insidious onset of pain. • History of over use, involving forceful gripping, repetitive flexion- extension at wrist or pronation-supination activity. • Pain aggravated by movements like pouring out tea, turning stiff door handle, shaking hands, lifting weights,etc. • Elbow looks normal and flexion and extension are full and normal.
  • 10. Physical Examination • Localised tenderness at or just below the lateral epicondyle • Cozen’s test: painful resisted extension of the wrist with elbow in full extension elicits pain at the lateral aspect of elbow • Mill’s test: Elbow held in extension ,passive wrist flexion and pronation produces pain. • Maudsley’s test: examiner resist the extension of third digit of hand , stressing the extensor digitorum muscle and tendon. A positive test is indicated by pain over lateral epicondyle.
  • 14. Differential diagnosis • Radial tunnel syndrome: posterior interosseous nerve entrapment between the fibres of supinator muscle. Clinically pain will increase with resisted supination. Pain is located 3- 4cm distal to lateral epicondyle. • Osteochondritis dissecans of the elbow: patient may complaint of snapping or locking. Maximum tenderness found posterior to lateral epicondyle.
  • 15. Imaging • Not routinely performed • Diagnostic ultrasound features include:  In active severe disease- neovascularisation  Local fluid collection  In chronic cases- dystrophic calcification at tendon insertion
  • 16. Conservative Treatment • 90% of ‘tennis elbow’ will resolve spontaneously within 6-12 months. • First step is to identify and restriction or modification of the activities which cause pain. • In acute stages use of ice pack, use of NSAIDS(preferably topical) can be useful. • Compression strap applied distal to bulk of extensor mass(to reduce maximum contraction) is helpful. It is used only during aggravating activity. • Injection of tender area with corticosteroids and local anaesthetic relieves pain but is not curative. • Physical therapy: ultrasound therapy, remedial exercises may be effective in long term
  • 20. Operative treatment • Indicated in sufficiently persistent or recurrent cases usually after 6- 12 months of failed conservative management. Options : I. Open debridement of the diseased tissue of the ECRB II. Percutaneous release III. Arthroscopic debridement
  • 24. Newer experimental treatments • Injections : autologous blood, platelet rich plasma , botulinum toxin • Laser therapy • Extra corporeal shock wave therapy
  • 25. Extra corporeal shock wave therapy
  • 27. Bibliography • Apley’s system of orthopaedics and fracture, 9th edition • Oxford Sports injuries by Michael Hutson and Cathy Speed • Textbook of orthopaedics by John Ebnezar, 4th edition • Essential handbook of practical orthopaedic examination by Kaushik Banerjee, 4th edition • Essential orthopaedics by Maheshwari, 5th edition