Case Study On Tennis Elbow

CASE STUDY ON TENNIS ELBOW
INTRODUCTION
It was first described from the Writer’s cramps by Range in 1873. It was Madris
who called it as “tennis elbow” shortly thereafter”.
Definition: - Painful elbow syndromes encompass lateral, medial and posterior

elbow symptoms. The one commonly encountered is the lateral tennis elbow
which is known as the classical tennis elbow and is the pain and tenderness on
the lateral side of the elbow, some well defined and some vague that result from
repetitive stress.
Lateral tennis elbow :- it is lesion affecting the tendinious origin of common

wrist extensors.
Causes:-
1. Epicondylitis, this is due to single and multiple tears in the conmon

extensor origin, periosteitis, angiofibroblastic proliferation of extensor
carpi radialis brevis.
2. Inflammation of adventitious bursa between the common extensor origin
and radiohumeral joint.
3. Calcified deposit within the common extensor tendon.
4. Painful annular ligament is due to hypertrophy of synovial fringe between
the radial head and capitulum.
5. Pain of neurological origin, e.g. cervical spine affection, radial nerve
entrapment.
6. Seen in :-
 All level of tennis players.
 In world class players “SERVE’ appear to be the cause.
 In less than world class players “backhand stroke”.
 Seen in other sports also, may be occupational, etc
 Activities other than tennis which lead to tennis elbow: tightening a
screw, using a wrench, wringing washed clothes, vigorous hand
shake.
PATHOPHYSIOLOGY
STAGES 1:- There is acute inflammation but no angioblastic invasion. Patient
complains of pain during activity.
STAGES 2:- This is the stage of chronic inflammation. There is some

angioblastic invasion. Patient complaint pain during activity and at rest.
STAGES 3:- chronic inflammation with extensive angioblastic invasion. Patient

complains pain at rest, night pains, and pain during daily activities.
Literature Review
1) P.A.A. Strijs, etal. 2004, “Conservative Treatment of Lateral Epicondylitis:
Brace Versus Physical Therapy or a Combination of Both—A Randomized
Clinical Trial” concluded that Brace treatment might be useful as initial
therapy.
2) A. Sinclair, etal. “TENNIS ELBOW IN INDUSTRY” CONCLUDED THAT patients
are treated by physical methods only, viz., manipulation, ultrasonic radiation,
and short wave diathermy is more useful for relieve pain and stop
inflammation.
3) John Ebnezar , textbook of orthopaedics, fourth edition, explained about the
physiotherapy treatment during acute phase are rest, TENS, Cryotherapy,
electrical stimulation, Gentle massaging, manipulation.
Mechanism of ingury :-
Repeated motion of left hand
Chief complaint :- difficulty in ADL’S, patient feel sever pain to lift any object,
difficulty in job activities.
Full assessment of ingury :-
Date of assessment - 08/12/19
Subjective evaluation :-
Name – XYZ
Age – 40Y/F
Occupation: - Dental surgeon
Address: - JSPL, Raigarh.
Hand dominance: - left
c/o pain in left hand at lateral epicondyle and radiating to extensor group of
muscles.
Medical history: - Kept on pain medication when pain is severe, use Dynapar
QPS spray to decrease muscles tightness and decrease inflammation.
History of present illness: Patient feel sever pain from 5 days.
History of past illness: - Patient has history of tennis elbow 6 month ago. And
got treatment in physiotherapy department of Fortis OP Jindal, Raigarh.
Personal history:- ADL’S disturbed due to her present symptom.
Family history:- not relevant.
Pain :- site – at lateral epicondyle of left hand and radiating upto index &
middle finger and in extensor group of muscles.
Constant & aggravated with movement (as told by patient).
Irritability – moderate to higher (symptom aggravated with movement)
Aggravating factors :- lifting any object, when combine movement of left hand
with flexion at elbow & extension at wrist & radial rotation of wrist is very
painful and felt radiating pain at lateral epicondyle.
Relieving factors :- return back to neutral position of elbow, hand and wrist
(rest).
Objective evaluation :- posture is neutral.
Patient came to physiotherapy department independently by walking.
Full ROM at elbow but flexion movement is pain full for patient.
Full ROM at wrist but wrist extension is painful.

Special test :-
1) Local tenderness on the outside of the elbow at the common extensor

origin with aching pain in the back of forearm.
2) Cozen’s test: - painful resisted extension of the wrist with elbow in full
extension elicits pain at lateral elbow.
3) Mill’s test:- Elbow held in extension, passive wrist flexion and pronation
produces pain.
Provisional diagnosis:- tennis elbow
Problem list :-
1) Pain on movement of left hand

2) Difficulty in ADL’s
3) Tightness in extensor group of muscles
4) Tenderness at lateral epicondyle.
Short term goal:-
1) Reduce pain
2) Flexibility of tighten muscles
3) Reduce tenderness
4) Stop inflammation
5) Decrease overuse activity
Long term goals:-
1) Strengthening of elbow flexors and wrist extensors

2) Improve ADL’s
Physiotherapy management of short term and long term goals:-
1) Guide to avoid the overuse activities of affected hand and take

precautions to avoid them.
2) Thermotherapy – heat modalities like TEN’s, hot pack helps in reducing
pain.
3) Manual therapy (STM), gentle release for 10 days followed by friction
massage for the next 15 days to relax the tighten muscles.
4) Ultrasonic therapy: - used to decrease inflammation at lateral epicondyle
& also helpful in reducing pain.
REFERENCES:-
1) P.A.A. Strijs, etal. 2004, “Conservative Treatment of Lateral Epicondylitis:

Brace Versus Physical Therapy or a Combination of Both—A Randomized
Clinical Trial”
2) A. Sinclair, etal. “TENNIS ELBOW IN INDUSTRY”
3) John Ebnezar, textbook of orthopaedics, fourth edition, “Essentials of

Orthopaedics for Physiotherapists”.

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CASE STUDY ON TENNIS ELBOW

Definition: - Painful elbow syndromes encompass lateral, medial and posterior

Lateral tennis elbow :- it is lesion affecting the tendinious origin of common

1. Epicondylitis, this is due to single and multiple tears in the conmon

STAGES 2:- This is the stage of chronic inflammation. There is some

STAGES 3:- chronic inflammation with extensive angioblastic invasion. Patient

Full assessment of ingury :-

Date of assessment - 08/12/19

Occupation: - Dental surgeon

Address: - JSPL, Raigarh.

Hand dominance: - left

History of present illness: Patient feel sever pain from 5 days.

Personal history:- ADL’S disturbed due to her present symptom.

Family history:- not relevant.

Constant & aggravated with movement (as told by patient).

Irritability – moderate to higher (symptom aggravated with movement)

Objective evaluation :- posture is neutral.

Patient came to physiotherapy department independently by walking.

Full ROM at wrist but wrist extension is painful.

1) Local tenderness on the outside of the elbow at the common extensor

Provisional diagnosis:- tennis elbow

1) Pain on movement of left hand

Short term goal:-

Long term goals:-

1) Strengthening of elbow flexors and wrist extensors

Physiotherapy management of short term and long term goals:-

1) Guide to avoid the overuse activities of affected hand and take

1) P.A.A. Strijs, etal. 2004, “Conservative Treatment of Lateral Epicondylitis:

2) A. Sinclair, etal. “TENNIS ELBOW IN INDUSTRY”

3) John Ebnezar, textbook of orthopaedics, fourth edition, “Essentials of

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