PHYSIOTHERAPETIC DIAGNOSIS OF
LATERAL ELBOW PAIN
Dr. E. Praveen. M.P.T (Musculoskeletal Physiotherapy)
Head of the department,
Spectrum Physio Centre
Sita
Bhateja Speciality Hospital, Bangalore.
Lateral elbow pain is a common clinical problem and mostly
misdiagnosed as tennis elbow in clinical scenario. Physiotherapy diagnosis is
an looking an anotomical and therapeutic way of pain contributing mecahnism to
estabilish the physiotheray treatment, which is inevitable process in clinical
decision making process for lateral elbow pain. Lateral elbow pain can occur
because of variety of reasons, Because of the multifactorial nature of the
condition it is essential that an accurate diagnosis is established early and
that a management plan is instigated.
Tennis elbow can be defined as “Chronic overuse syndrome
affecting the common extensor origin at lateral humeral epicondyle, resulting
in localized pain tenderness and painful movements of wrist and forearm”
The initial assessment of patients with acute and subacute
elbow problems should focus on detecting clinical indications of potentially
serious disease, termed red flags, and determining an accurate diagnosis. In
absence of redflag, Physiotherapist must
access the pain controbuting factors to make the treatment oriented
physiotherapeutic diagnosis.
Pathophysiology of Tennis elbow (Nirschi &
Pettrone 1979) Microscopic tear of ECRB due to Reparative mechanism
(angioblastic hyperplasia), which leads to Macroscopic tear of ECRB Muscle. ECRB
Tear makes the structural failure Radio humeral bursitis periosteal reaction,
which cause tennis elbow.
Stages of tennis elbow (Nirschi & pettrone 1979)
Stage 1 - Inflammatory
changes that are reversible
Stage 2 - Nonreversible
pathologic changes to origin of the ECRB muscle
Stage 3 - Rupture of ECRB
muscle origin
Stage 4 - Secondary changes
such as fibrosis or calcification
Presence
of swelling indicates Arthritis, Synovitis, Infection, Trauma or Tumour.
Swelling, night pain and any patient dose not reflecting the clear therapeutic
diagnosis need to send for expert orthopaedic opinion for acute medical
management.
Lateral elbow – from
physiotherapeutic perspective.
S.No
|
Physiotherapeutic
diagnosis
|
Physiotherapy
Treatment plan
|
1
|
Cervical
spine dysfunction
– Cervical disc lesion which entrap the cervical nerve roots
|
Cervical
Mobilization Techniques,
|
2
|
PIN
Entrapment / Supinator syndrome
– Where the supinator muscle strain compress the posterior interossei nerve
near elbow cause elbow pain.
|
Supinator MET,
Neural mobilization, Physical modalities
|
3
|
Habitual
anterior translation of radius – More
anterior translation of radius during
elbow flexion
cause elbow pain
|
Mulligan
posterior glide for elbow and mulligan tapping
|
4
|
Real
Tennis elbow –
Tendo periosteal
inflammation/ Myo
tendineous inflammation due to over stain
|
Therapeutic
ultrasound therapy, TENS, Rigid tape, Brace, Rest,
|
5
|
ECRL
/ECRB Strain muscle strain
Acute elbow pain
after the sudden overuse of elbow joint.
|
TENS, Cyriax
mobilization, Mills manual therapy,
Tennis elbow band
|
6
|
Myofacial
Trigger point - Presence of TrPt at Supinator,
Brachioradialis, Extensor carpi radialis longus, Triceps brachii, Supraspinatus,
Anconeus leads to later elbow pain.
|
Trigger point
treatment approaches like Dry Needling, trigger point therapy, instrument
assisted MFR, T Bar, Muscle energy technique…
|
7
|
Neural
mobility –
Neural shortening due to inadequate stretching and neural mobility issues
also leads to nerve root pain and elbow pain. (ULTT2B Radial nerve)
|
Neural stretches,
Neural sliding, Nerve tissue mobilization approaches.
|
8
|
Wrist
ligament injury-
Traumatic wrist injury and RSI of wrist can also leads to radiating pain and
overuse injury of wrist muscles.
|
Wrist
immobilisers, Electrotherapy and thermotherapy treatment for wrist
|
9
|
Degenerative
arthritis - Rheumatoid arthritis, Gout arthritis,
Pseudo osteoarthritis can cause elbow pain
|
Electrotherapy
and thermotherapy treatment for wrist.
|
10
|
Olecranon
bursitis – Popularly
known as student elbow due to direct constant contact pressure at elbow
|
Rest, patient
education, Electrotherapy and thermotherapy treatment
|
11
|
Cubital
Tunnel Syndrome and Radial Tunnel Syndrome – Common nerve entrapment at
forearm cause elbow pain.
|
Ergonomics advice,
Nerve glides exercise, stretching and strengthening, Electrotherapy and
thermotherapy treatment.
|
Conclusion:
All
the elbow pains are not tennis elbow and lateral elbow pain must be
comprehensively assessed and critically analysed. Physiotherapeutic diagnosis
of elbow pain must guide the physiotherapist in clinical decision making
process of treatment selection in clinical practise.
