CASE PRESENTATION

UCP/AL/11/183

Subjective Examination

1. Name : I.M. Ranjanee2. Age : 56 years3. Sex : Female4. Address : Kelaniya 5. Civil Status : Married6. No. of children : 47. Occupation :seamstress8. Present complaints: pain over the lateral aspect of elbow for the past 4 months

9. Pain : Location: lateral aspect of elbow and radiating down sometimes Onset: gradual, no history of trauma Type : aching pain Aggravating factors: cutting with scissors, carrying heavy loads, squeezing,washing clothes

Easing factors: rest 24 hour behaviour : worse at night, stiffness in hand in

morning Worsening/ better/ same ? Worsening

10. Sensation (paresthesia, numbness) : none

11. Past medical history : no HBP , no diabetes

Objective Examination

Observation Observed from anterior, posterior,lateral

aspects1. Bony and soft tissue contours: normal 2. Colour of skin: normal3. Carrying angle : normal (equal in both

limbs)4. Normal functional position could be

obtained (90 flexion, forearm mid position)

Palpation : Medial and lateral epicondyles and

supracondylar ridges Radial head Radiohumeral joint line Olecranon process Common extensor and flexor origins Bicipital tendon

Palpation of lateral epicondyle and common extensor origin elicited pain.

Examination: AROM : elbow flexion/extension, forearm supination/pronation,

wrist flexion/extension, wrist ulnar/ radial deviation normal wrist and MTP flexion and pronation painful

PROM : normal end feels normal

Resisted isometric movements : wrist extension and flexion painful, MTP extension painful

Functional assessment : grip strength of affected limb comparatively lesser than the unaffected limb

standard fist, hook grasp – normal pulp to pulp thumb to all fingers/ tip to tip thumb to all

fingers - normal

Special Tests :

1. Cozen’s test +2. Mill’s test +

Physiotherapy Diagnosis

Lateral epicondylitis ( Tennis elbow) no neurological symptoms ( no

cervical pathology) bony and soft tissue contours

normal/ ROM not restricted( no dislocation or # )

Treatment Plan

o Short term goals - Pain relief break adhesionso Long term goals - Restore ROM Muscle strengthening Pain relief = Ultrasound : 0.5 Wcm-2 , continuous mode, 1:2 Mark space ratio for 8

min on alternate daysBreak adhesions =Ultrasound Transverse frictions : 10 minutes per day on alternate daysRestore ROM = ROM exercises for fingers and wrist : flexion , exrensionMuscle strengthening = grip strengthening exercises Advising patient to avoid movements involving extensive use of forearm extensors such

as cutting, carrying heavy load

Justification of Treatment Plan

Ultrasound : chronic , superficial tissue local heating helps break adhesions and reliefs pain

Transverse frictions : pettrisage , mobilises the tendon , breaks adhesions

ROM exercises : maintains ROM , prevent joint stiffness

Muscle strengthening : improve functionality , improve grip

advise : to prevent constant micro tears occurring to the tendon

Outcome Measurement

Pain Numeric Pain Scale Grip strength dynamometer Functional assessment

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