Epicondylitis Lateralis

Mubarak M.D 1
Data Base : (6-4-2011)
Identity

• Name : Mr. A
• Sex : Male
• Age : 39 y.o.
• Address : Surabaya
• Occupation : Security of Newspaper
“Surya"
• Religion : Moslem
• Ethnic : Java
• Marital status : Married

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Patient came to PMR Referred from Jamsostek Clinic with Dx.
Susp. Dislokasi Articulatio Cubiti D
Chief Complaint :
• Nyeri siku kanan
History of Present illness
He felt pain on his right elbow since a month ago.
The pain occured after he tried to chop the tree with
large knife by hitting the knife for many times to the
log and using a lot of effort. After this he started to
feel “ngilu” on his elbow, he thought it would last for
a week but untill now it even worse
The pain increased when he lifted things with his
right arm. The pain also occurred when he wanted
to fully straighten or bend his elbow and to gas the
motorcycle pedal.
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He used shoulder pad to relieve the pain. When he rest his
arm the pain started to relieved.
He didn’t complain for tingling or weakness of his arm.
He works as a security on Newspaper Surya, he is not
used to work hard with his arm. 1 month ago his office did
“kerja bakti” and he chop the tree and this when he started
to feel pain the first time.
He still could do his daily activities, but feel disturbed by the
pain

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History of past illness
• There was no diabetes mellitus nor hypertension
• There was no history of elbow trauma

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PHYSICAL EXAMINATION
General Status
• CM, independent ambulation, gait normal, right
handed, BP : 120/60 mmHg, HR : 72 x/minutes, RR :
20x/m

Head & Neck : there was no anemia, icterus, cyanosis

& dyspneu
Thorax : Cor : s1-s2 sound, murmur –
Pulmo : vesicular, wheezing -/-,
ronchi -/-Abdomen :Meteorismus - , Hepar/Lien
unpalpable
Extremities : warm acral +/+

VAS : 4

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PHYSIATRIC EXAMINATION
Musculoskeletal Examination
ROM MMT
Cervical
Flexi F(0-45°) 5
Extension F(0-45°) 5
Lateral flexion F/F(0-45°) 5/5
Rotation F/F(0-60°) 5/5

Trunk
Flexion F(0-80°) 5
Extension F(0-30°) 5
Lateral flexion F/F(0-35°) 5/5
Rotation F/F(0-45°) 5/5

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Shoulder
Flexion F/F(0-180°) 5/5
Extension F/F(0-80°) 5/5
Abduction F/F(0-180°) 5/5
Adduction F/F(0-45°) 5/5
Ext. Rotation F/F(0-45°) 5/5
Int. Rotation F/F(0-55°) 5/5

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Elbow
Flexion F/F(0-150°) 5/5
Extension F/F(150-0°) 5/5
Forearm Sup F/F(0-80°) 5-/5 (pain)
Forearm Pro F/F(0-80°) 5-/5 (pain)

Wrist
Flexion F/F(0-80°) 5/5
Extension F/F(0-70°) 5-/5 (pain)
Radial deviation F/F(0-20°) 5/5
Ulnar deviation F/F(0-30°) 5/5

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Fingers
Flexion
MCP F/F(0-90°) 5/5
PIP F/F(0-100°) 5/5
DIP F/F(0-90°) 5/5
Extension F/F(0-45°) 5-/5 (pain)
Abduction F/F(0-20°) 5/5
Adduction F/F(20-0°) 5/5

Thumb
Flexion
MCP F/F(0-50°) 5/5
IP F/F(0-90°) 5/5

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Extension F/F(0-90°) 5/5
Abduction F/F(0-50°) 5/5
Adduction F/F(50-0°) 5/5
Opposition F/F(0-90°) 5/5

Hip
Flexion F/F(0-125°) 5/5
Extension F/F(0-30°) 5/5
Abduction F/F(0-45°) 5/5
Adduction F/F(0-20°) 5/5
Ext. Rot F/F(0-45°) 5/5
Int.Rot F/F(0-45°) 5/5

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Knee
Flexion F/F(0-135°) 5/5
Extension F/F(135-0° 5/5

Ankle
Plantar flexion F/F(0-45°) 5/5
Dorsi flexion F/F(0-30°) 5/5
Inversion F/F(0-35°) 5/5
Eversion F/F(0-25°) 5/5

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Toes
Flexion
MTP F/F(0-30°) 5/5
IP F/F(0-50°) 5/5
Extension F/F(0-80°) 5/5

Big Toe
Flexion
MTP F/F(0-25°) 5/5
IP F/F(0-25°) 5/5
Extension F/F(0-80°) 5/5

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Neurological examination
• N. Cranialis I –XII : Normal
• Physiological Reflex : BPR +2/+2
TPR +2/+2
KPR +2/+2
APR +2/+2
• Pathological Reflex : Babinski -/-, HT -/-
• Sensory deficit : -/-

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Localize status

Right elbow
I : swelling -, redness -, deformity -
P : tender point at the right lateral
epicondyle

Special test :
Yergason test : -/-
Tinnel sign : -/-
Phalen test : -/-
Prayer test : -/-
Chair test : +/-
Thomson test : +/-
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Diagnosis

Medical diagnose : Right Epicondylitis Lateral

Functional diagnose :

Impairment : Right Epicondylitis Lateral

Disability : Difficult to lift objects with the right hand

Handicap :-

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3. Problem list :
• Surgical :-
• Medical : Right Epicondylitis Lateral
• Rehabilitation Medicine :
R1 (Mobilization) :-
R2 (ADL) : Difficult to lift objects with
the right hand
R3 (Communication) :-
R4 (Sociological) :-
R5 (Psychological) :-

R6 (Vocational) :-
R7 (Others) : Pain at the lateral side of the
right elbow. VAS: 4

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Planning :
• Surgical : -
• Medical : -
• Rehabilitation Medicine
P. Dx : -
P. Tx :
1. USD at area of lateral epicondyle right elbow, Freq.
3MHz, continuous mode, intensity 1,5 W/cm2, duration 8
min
2. Laser at the tenderpoint of lateral epicondyle right
elbow
P. Mx : Clinical sign and symptoms
P. Ed. : Health Education & Home Exercise Program
- warm water compress
- ROM & stretching exercises gently at home
-temporarily avoid lifting heavy objects with the right hand

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Summary
It has been reported a patient, male 39 y.o., came with the
chief complaint “nyeri pada siku kanan”. Pain on the right
elbow felt since a month ago. , after chopping tree with high
effort. The pain increased when he lifted things with his
right arm. also when he wanted to fully straighten or bend
his elbow or gas the motorcycle pedal. He still could do his
daily activities, but disturbed by the pain.

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From the physical examination was found slight decrease
of MMT (5-) on Right elbow supination-pronation, wrist
extension, and finger MCP extension because pain. Tender
point at right lateral epicondyle and Chair, Mill,and
Thomson test positive at the right elbow.
The diagnose is Right Epicondylitis Lateralis.
No planning diagnostic.
The planning therapy is USD at right epicondyle, planning
monitoring with clinical signs and symptoms. The planning
education is warm water compress, ROM & stretching
exercises at home, and temporarily avoid lifting heavy
objects with the right hand.

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Any Question
???

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Background

• The condition commonly called “Tennis Elbow” is

probably the most frequent sport-related elbow complain
although it also occurs in non-athletes
• It is more frequently seen in computer use, heavy lifting,
forceful forearm pronation and supination.
• Men and women with equal frequency

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Pathophysiology

• Inflammation reaction within the tendon origin and

progresses to microtear of the fibers of the tendon that
heal through fibrosis and than occur tissue failure

• Most commonly involve the origin of the Extensor Carpi

Radialis Brevis (ECRB)

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• Less commonly involves the origin of
the Extensor Carpi Radialis Longus
(ECRL) Extensor Digitorum Communis
(EDC) or Extensor Carpi Ulnaris

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Anatomi :

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Causative factors

• A very common overuse condition caused by repeated

minor trauma that strain the wrist extensors musculature
at the lateral epicondyle

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 The clinical presentation

• Tenderness just distal to the lateral epicondyle at the

extensors origin.

• Pain and weakness in grip strength

• The diagnosis is made by resisting the patient’s wrist

extension and radial deviation with the elbow fully
extended. Pain and tenderness are felt at the lateral
epicondyle.

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Treatment
I. Conservative
1. Immobilization –
* Resting the involved extremity and avoiding
activities that produce symptoms (computer
work, gripping with palm down, sports).
* functional wrist bracing; forearm brace.

2. Modality therapy :
- Acute stage : Cold therapy
- Chronic stage : Ultra sound diathermy , TENS

3. Medication :
NSAIDs oral , Corticosteroid Injected

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4. Therapeutic exercise
• emphasize for the restoration of function of the involved
muscle group with improvement Flexibility, strength, and
endurance of the wrist extensor muscle group.
• ROM for wrist flexion/extension and pronation/supination
• Strength and grip training

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4. Therapeutic exercise

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II. Surgical intervention
Generally reserved for chronic conditions that are
unresponsive to conservative management and are
associated with significant limitation in functional performance

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