Lateral epicondylitis Flashcards
Hx
40 yr old carpenter/ motor bike fanatic w/ pain on outside of elbow, pain worst at end of day or after long bike journey, pain radiates down forearm, localises pain just distal to medial epicondyle
look/ inspect
nil of note
feel
pain on palpation1cm distal to lateral epicondyle
active movement
pain on wrist extension
passive movement
minimal pain
resisted movement
pain exacerbated with resisted wrist extension
other exams
neuro exam of hand
c spine exam cervical radiculopathy/ radial nerve impingement
DDx
tennis elbow/ lateral epicondylitis
cervical radiculopathy
radial nerve impingement
Why is tennis elbow likely?
typical hx of pain annd a career and hobby that involve repetitive wrist extension
exam tenderness distal to lateral epicondyle and pain on resisted wrist extension
why is cervical disc disease unlikely?
no pain in c spine
normal neuro exam
why is radial nerve impingement unlikely?
normal distal neuro exam with full power of wrist extension
investigations?
clinical dx, imaging not required
but if imaging is required
xray - if ddx is osteochondral defect/ OA
nerve conduction studies - radial nerve impingement
U/S - dx of partial tendon tear
non-op tx
analgesia
watchful waiting - 1 yr
refer to physio
refer to ortho
op tx
reserved for refractory cases 6 months of non-op tx
arthroscopic/open debridement of pathological tissue within tendon of ECRB
