CASE PRESENTATION ON

TENNIS ELBOW

Sudipta Bhowmick
DEMOGRAPHIC DETAILS:
Name : Avinash Singh
Age: 28 years
Sex: Male
Address: 64/7, Jagrati Vihar Meerut
Occupation: Call Center Employee
Chief complaint: Patient complains of a pain and swelling
over the elbow with difficulty in gripping and
movements of the wrist hurt, especially wrist extension
and lifting movements.
HISTORY
H/Present illness: Patient came with a history of severe
pain over the outer border of his elbow that travels down
to the back of his forearm . He stated that he recently
came back from a trip to Amritsar.Where he drove
approximately for 400 miles . Later for business he
carried a heavy brief case with his right arm fully
extended by his side.
Past history: None.
Social history:
 Unmarried

 Non Smoker

 Vegetarian

 Non alcoholic
PHYSICAL EXAMINATION
 B.P.: 128/80mmHg
 Pulse rate:72/min

 Respiratory rate:16/min

 Body built: Endomorphic

 Swelling: Present

 Pain : Present (burning)

 Severity of pain: Moderate

 Onset : Sudden
 Distribution: Lateral Pain on the outer part of elbow
(lateral epicondyle) of right hand.
 Tenderness :Present over the lateral epicondyle

 Aggravated by: Gripping and movements of the wrist

hurt, especially wrist extension and lifting movements.
 Eases by: Analgesic or counter irritants(gels).
 Sleep disturbances: Present.
Local Examination:
 Swelling: Present

 Skin Condition: Blueish

 Scar: None

 Muscle Wasting: None

 Attitude: Patient keeps the elbow flexed and pronated.

ON PALPATION:
 Tenderness: Present
 Bony irregularity: None

 Swelling: Present and is progressive.

 Abnormal Movements: None

 Crepitus: None
CIRCUMFERENCE (CM)
Lt. Rt.
On joint 23 25
Above joint 27 29
Below joint 21.5 22
MUSCLE POWER:
Lt. Rt.
EL -Flexors 5 4
Extensors 5 3
Supinators 5 3
Pronators 5 4
Wri -Flexors 5 3
Extensors 5 4
Radial Deviators 5 3
Ulnar Deviators 5 4
ROM:
ROM ACTIVE –PASSIVE ACTIVE-PASSIVE
(RIGHT) (LEFT)
El-FLEXION 125 135 0-140 0-145
EXTENSION 130-0 140-0 0 0
PRONATION 60 70 0-70 0-75
SUPINATION 50 60 0-75 0-80
WRI-FLEXION 40 45 0-65 0-70
EXTENSION 40 50 0-70 0-75
RADIAL DEVIATION 7 10 0-15 0-20
ULNAR DEVIATION 20 25 0-30 0-30
INVESTIGATION:
 X-RAY: Did not reveal any abnormality.

Special tests:
 Mill’s Test is positive.
 Maudsley’s test is positive.
 Varus Stress Test is positive.
TREATMENT

MEDICAL MANAGEMENT
 PRICE
 NSAIDS
 Local injection of hydrocortisone with local anesthetic
solution relieves pain.
PHYSIOTHERAPY MANAGEMENT

 ACUTE PHASE
 SUPPORTIVE MEASURE &REST- Initially rest with a
splint holding wrist in mild degree of extension and sling
with elbow in flexion & forearms in supination.
 CRYOTHERAPY
 ELECTRICAL
 ULTRASOUND
 TENS
 EXERCISE- Gentle active movts. Of elbow, wrist & hand &
isometric movt.
 RESISTIVE EXERCISES
 POST ACUTE PHASE
 Patient is instructed to avoid repeated wrist extension & 
supination movts.
 EXERCISE
 PASSIVE EXERCISE- In the supine position , relaxed
passive movts of the elbow flexion & forearm supination are
carried out in its complete range.
 RESISTED EX- When a painless range of movts are
achieved by the passive ex progressed to PRE are advised.
 STRENGTHENING EX- Strong isometric exercise to the
triceps.
THANK YOU!