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Nyeri pada tennis elbow tipe II

tennis elbow tipe II


Functioning, and disability Constextual factors

Anatomic impairment

Muscle Capsels-Lig Internal factors External factors

Upper extremity ms
Capsular contracted
Extensor carpi- Elbow fault lig. Collateral
radialis brevis Alignment mediale/-laterale
Valgus Varus
Functional
impairment Activity
Repetitive injury limitation
Participation
Tendoperiosteal Movement restriction
inflammation disfunction Grip/dexterity

Adhesion Work

ADL Sport
Nyeri siku

Recreation
Hipomobility
PEMERIKSAAN FISIOTERAPI YG
DIBUTUHKAN
 Diutamakan pemilihan evidence
untuk:
◦ Pemeriksaan alignment lengan
◦ Pemeriksaan capsels dan ligament
◦ Pemeriksaan kekuatan kelenturan otot
◦ Pemeriksaan fungsi lengan
◦ Pemeriksaan disabilitas
FISIOTERAPI YG DIBUTUHKAN
 MODALITAS DAN METODA
◦ Anatomic target
◦ Functional target
◦ Impairment target
◦ Disability target
 Contoh:
◦ US Tendo periosteal
◦ Transverse friction
◦ Strengthening otot lengan dan tangan
misal dengan pain free grip strength
◦ Latihan fungsional
◦ Dll
ALAT UKUR/EVALUASI
FISIOTERAPI YG DIBUTUHKAN
 Pengukuran nyeri
 Pengukuran fleksibilitas/ekstensibilitas
otot
 Pengukuran ROM,
 Pengukuran movement dysfunction
 Pengukuran disabilitas
ELBOW PAIN - TENNIS
ELBOW
Degeneratif,
Injury back hand, Inflamasi kronik
vokasional

ROM normal, Stretch test Palpasi lateral


Nyeri lateral
isometric wrist nyeri lateral epicondyle nyeri:
epicondyle
dorsal flex epicondyle Tipe I, II, III / IV

Chronic inflam,
Critical zone,
tisue adhesion

Ultra sound Transverse friction

Mill’s manipulation

Pain free grip strength Nerve gliding technique Sugijanto, 2014


Process of Manualtherapy for
Muscle impairment
Pasif:
terbatas
springy
Transverse
friction
Isometric:
Nyeri
Nyeri
kontraksi Bila Mill’s
Bila negatif
positif manipulation
Palpasi:  ganti
Nyeri - hipotesis
hipertonia lain Pain free
strengthening
Pain free grip exc
test

Sugijanto, 2014
EXTENSOR CARPI RADIALIS LONGUS M. Superficial layer

O: lateral side of humerus above lateral. epicondyl


I: dorsal side of base of 2. metacarp
Fce: extension and ulnar duction of hand
Inn: radial n.

EXTENSOR CARPI RADIALIS BREVIS M.

O: lateral epicondyl of humerus


I: dorsal side of base of 3. metacarp
Fce: same as ECRL (previous m.)
Inn: radial n.

Sugijanto, 2014
Elbow Muscle Power Deficits
ICD-9-CM code: 726.32 Lateral epicondylitis
ICF codes: Activities and Participation code:
d4300 Lifting, d4452 Reaching, d4401
 Grasping
 Body Structure code: s73012 Muscles
of forearm
 Body Functions code: b7300 Power of
isolated muscles and muscle groups

Sugijanto, 2014
PEMERISAAN FUNGSI GERAK
DASAR
 Tc
 Gerak siku kadang nyeri
 Gerak ekstensi pergelangan
tangan nyeri pada siku
 Tes fungsi
 Gerak fleksi dan ekstensi penuh
nyeri
 Gerak pasif pergelangan tangan
fleksi penuh nyeri
 Gerak isometrik dorsal fleksi
Sugijanto, 2014
pergelangan tangan nyeri pada
TES KHUSUS
 Tes khusus
 Palpasi: nyeri pada titik-titik tipe I:
Tendon extensor carpiradialis longus;
tipe II: Tendoperiosteal extensor
carpiradialis brevis; tipe III: Tendon-
muscular juction extensor carpiradialis
brevis; dan tipe IV: tengah otot
extensor carpiradialis brevis.
 Mill’s test
 Pain free grip strength test
 Idntifikasi titik nyeri/sensitif Sugijanto, 2014
Pain Free Grip Strength

Prof. Bill Vicenzino

Sugijanto, 2014
Pain free grip strength

Sugijanto, 2014
INTERVENSION
Intervensi:
Ice
US.
Transverse friction (lokasi tertentu),
Transverse friction
Mill’s manipulation
Pain fre grip strengthening exc,
splinting.
Reevaluasi: Nyeri.
Elbow splint
Neural mobilization Sugijanto, 2014