كل ما يخص ال Tennis Elbow من الالف للياء بالصور والفيديوهات والمصادر اللي جاي منها المعلومات .
ياريت قبل اي حاجة تعرفونا لو مهتمين و حابين نكمل شرح باقي الامراض والاصابات المهمة في مجالنا .
Definition :
Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.
It is a tendinopathy injury involving the extensor muscles of the forearm.
بالمعني البلدي كدا :
هو التهاب في الاوتار بتاعت الelbow لما بحمل عليها بشكل كبير ، طب بحمل عليها ازاي ؟ يعني لما استخدمها كتير واعمل نفس الحركات بصورة متكررة من غير ما يكون فيه اي راحة او rest وطبعا الاصابة بتأثرلي علي ال extensors بتوع ال Forearm لان الاصابة lateral .
طيب من اسمها كدا المفروض اللي بيلعبوا Tennis بس هما اللي يجيلهم الحالة دي صح ؟ لا غلط ، قالك ان 5% بس من اللي بيعانوا من الاصابة دي بيبقي بسبب ال Tennis ، و فيه ناس تانيين كتيير ممكن يجيلهم الحالة دي غير لاعبي ال Tennis وهنشرح ازاي وليه ..
⬅️ شوية معلومات بسيطة عن الحالة :
- قالك ان الاصابة بتحصل Lateral اكتر من ال medial بنسبة 4:1
- بتيجي من 1 ل 3% من السكان في العالم كله .
- بتيجي اكتر للي عندهم من 35 ل 50 سنة .
- نادرا جدا لما تيجي في الايدين .
- ال dominant hand هيا المعرضة الاكبر للاصابة .
- بتيجي equally في ال males وال females .
- 20% من الحالت بتفضل مكملة معاهم اكتر من سنة .
➡️ Causes :
You can develop tennis elbow by doing any form of activity that involves repeatedly twisting your wrist and using your forearm muscles.
Examples include:
1- playing racquet sports – such as tennis, badminton or squash
2- throwing sports – such as the javelin or discus
رياضة رمي الرماح او رمي القرص .
3- using shears while gardening
استخدام المقصات الكبيرة علشان الشجر .
4- using a paintbrush
فرشة الرسم
5- manual work – such as plumbing or bricklaying
العمل اليدوي زي السباكة او البناء .
6- activities that involve fine, repetitive hand and wrist movements – such as using scissors or typing or Carpentry
الانشطة اللي بيحصل فيها استخدام ال hand او ال wrist بشكل دقيق ومتكرر زي المقص او الكتابة او النجارة.
7- other activities that involve repeatedly bending the elbow – such as playing the violin
الانشطة اللي بيحصل فيها عمل flexion لل elbow بشكل متكرر زي الكمان.
➡️ Symptoms :
1- pain on the outside of your upper forearm, just below your elbow – the pain may also travel down your forearm towards your wrist
2- pain when lifting or bending your arm
الم عند رفع او تني الدراع.
3- pain when writing or gripping small objects – for example, when holding a pen
الم عند الكتابة او مسك الحاجات الصغيرة زي القلم مثلا .
4- pain when twisting your forearm – for example, when turning a door handle or opening a jar
الم لما يحصل التواء لل forearm ، زي فتح الباب او فتح برطمان .
5- pain and stiffness when fully extending your arm
الم وتيبس لما تيجي تفرد دراعك .
➡️ Subjective Assesment :
1- History: often results secondary to occupational/recreational/habitual overuse or as a result of change in loading patterns. This may need to be explored, as it is often not obvious to the patient.
غالبا ما بيحصل ثانويا نتيجة الاستخدام المهني او الترفيهي المفرط ودا بيبقي محتاج استكشاف علشان مبيبقاش واضح للمريض .
2- Pain: ache pain and/or a burning sensation around the lateral humeral epicondyle and often down the forearm. Intermittent sharp pains may occur when performing aggravating activities.
بيبقي فيه pain او burning sensation حوالين ال lateral epicondyle وبتنزل لل forearm وبيزيد الالم لما المريض يعمل انشطة مشددة .
➡️ Objective Assesment :
1- Palpation: Pain and point tenderness over lateral epicondyle and/or 1-2 cm distal to epicondyle. Swelling and ecchymosis are not typically present .
2- Grip Strength: The affected side had 50% grip strength when compared to the unaffected side.
ال affected side بيبقي فيه 50% من قوة القبضة مقارنة بالجانب السليم .
3- Resisted Extension: will likely be weakened and painful.
4- Neural Examination: should be performed. Useful to exclude cervical pathologies and other differential diagnoses. Frequently, radial nerve tension tests will be positive.
5- Weak elbow extensors and flexors
➡️ Diagnostic Procedures :
The diagnose starts with asking about the activity level , occupation risk factors, recreational sports participation, medication and other medical problems. During the physical exam, the doctor will feel the structure of the elbow and other joints. Also the nerves, muscles, bones and skin are examined. It’s important to know which activities cause symptoms and where on your arm the symptoms occur.
➡️ Investigation :
1- X-rays: These may be taken to rule out arthritis of the elbow.
2- Magnetic Resonance Imaging (MRI): if the symptoms are related to a neck problem, an MRI scan may be ordered. This will show if there is a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.
3- Electromyography (EMG): An EMG is used to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.
➡️ Special Tests :
هشرحهم هنا وهحطلكم ليهم فيديوهات ف الاخر كمان .
1- Cozen’s test :
Cozen’s test is also known as the resisted wrist extension test.
- بحط ال elbow في 90 درجة flexion ، ال therapist بيعمل بإيده palpation لل lateral epicondyle ، وبإيده التانية بيخلي ايد ال patient في radial deviation و pronation وبعدين ال patient بخليه يعمل resisted wrist extension
- The test is positive if the patient experiences a sharp, sudden, severe pain over the lateral epicondyle.
2- Mill's Test :
- ال patient بيقعد وال upper extremity بيبقي relaxed وال elbow في extension ، ال therapist بيعمل passive stretch لل wrist extensor وpronation .
- Pain at the lateral epicondyle or proximal musculotendinous junction of wrist extensors is positive for lateral epicondylitis.
3- Maudsley’s test :
- The examiner resist extension of the third digit of the hand, while palpating the lateral epicondyle. A positive test is indicated by pain over the lateral epicondyle.
4- The coffee cup test (by Coonrad and Hooper): While doing a specific activity such as picking up a full cup of coffee or a milk bottle. The patient is asked to rate their pain on a scale of zero to ten.
- وال patient ماسك في ايده cup او bottle بسأل ال patient عن الالم وهو يقول بقي درجة الالم من zero to ten .
➡️ Treamtent :
طبعا بيتقسم Surgery او Conservative وهنقول دا امتي ودا امتي .
➡️ Surgical Treatment :
Usually this is after a failed conservative treatment for more than 6 months.
بنجرب conservative الاول ، لو بعد 6 شهور ومفيش نتيحة بردو نعمل surgery بقي .
- Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone. The right surgical approach for you will depend on a range of factors. These include the scope of your injury, your general health, and your personal needs.
- Open surgery : The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow.
- Arthroscopic surgery : Tennis elbow can also be repaired using tiny instruments and small incisions.
➡️ Conservative Treatment :
اول حاجة بنعملها اننا بنبدأ نقلل ال pain بعد كدا بقي نشتغل نع المريض عادي ، طب بنقلل ال pain ازاي ؟
1- N-Said
2- Ice massage
3- Tens
4- Tape, straps, or braces for support
5- Ultrasound
6- Extracorporeal Shockwave therapy
7- Corticosteroids injection- Short term effect (<6 weeks) .
➡️ Exercises :
- Once the pain eases, you’ll move onto exercises. How long it takes to get better depends on the severity of your symptoms. It could take up to 8 weeks or even longer to see results.
ببدأ معاه Exercises بعد ما ال pain يقل .
- بشتغل معاه strenghting وstretching و mobilization .
هحطلكم كل ال Exercises في فيديوهات تحت علشان تشوفوا بتتعمل ازاي كويس .
⬅️ المصادر :
- المصدر الاول من 55 ريفرنس مختلفين :
https://www.physio-pedia.com/Lateral_Epicondylitis
- المصدر التاني :
https://orthoinfo.aaos.org/.../tennis-elbow-lateral.../
- المصدر التالت :
https://www.webmd.com/.../tennis-elbow-lateral-epicondylitis
➡️ Special Tests :
- Cozen’s Test:
https://youtu.be/8K7jzDIUpLI
- Mill's Test :
https://youtu.be/r_A84ox9JRM
- Maudsley’s Test:
https://youtu.be/BaxgmHT_2eQ
⬅️ فيديو فيه مجموعة من ال Exercises عظيمة جدا :
https://youtu.be/Lf695_IJO8g
⬅️ فيديو تاني لل Exercises :
https://youtu.be/BXAzcjxIHMg
⬅️ فيديو تالت لل Exercises :
https://youtu.be/rUEHnsY-PuQ
➡️ Mulligan for Tennis Elbow :
https://youtu.be/thUlPbCX4fU
حد مهتم وحابين نكمل بنفس الطريقة ؟
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