Featured Topic - Tennis Elbow - Quiz
Lateral epicondylitis, also known as 'Tennis Elbow' is a common ailment amongst far more than just tennis players. The causes of tennis elbow are many and varied, with tennis actually being one of the less common. This instalment of the Featured Topic includes two articles on the subject from our content partners. On this page you will find Article 2, a quiz which deals more with the many potential causes of tennis elbow.
- Article 1: Intro to Tennis Elbow
- Article 2: Quiz on Tennis Elbow
ARTICLE 2: TENNIS ELBOW QUIZ
Question: List the possible etiologies of tennis elbow.
Answer
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Direct Blunt Trauma
Direct blows may cause inflammation of the tendon or the myotendonous junction. These are perhaps the easiest of the etiologies to treat. Unfortunately it is also probably the least common.
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True overuse
Unfamiliar or non-routine overuse, routine overuse after time off, change of tool, change of working position etc. are all possible causes of tennis elbow. To determine this etiology takes careful questioning and a skeptical attitude, as there is a real urge to take the easy solution. Again treatment is relatively easy. The patient changes what they are doing or how they are doing it and the therapist treats the local pathology.
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C5/6 biomechanical dysfunction
This has been postulated to cause tennis elbow or tennis elbow type pain in a variety of ways. These include:- Pain referral: A careful scanning examination may reveal the presence of a small palsy. Sensation testing in particular may help, demonstrating hypoesthesia in the C5 or 6 dermatome.
- Interruption of axoplasmic flow and consequent tropic malnutrition and increased vulnerability to otherwise innocuous stresses: Much more difficult to demonstrate and it may be possible only by excluding other possibilities. There should be a biomechanical dysfunction at C5/6 and there may be evidence of segmental facilitation.
- A minimal palsy resulting in either weakness and/or neuromuscular incoordination and subsequent tendon injury: See a.
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Segmental facilitation with hypersensitivity of
the tenoperiosteal attachment: There will be a
biomechanical dysfunction at C5/6. There should
also be hypertonicity in the local spinal muscles
and possibly in those muscles derived from this
segment particularly the wrist extensors. Also
look for hyperesthesia in the dermatome. A quick
test is to retest the positive isometric wrist
extension with the head held in varying
positions. If there is a complete relief of pain
when the head position is altered, there is no
local pathology and segmental facilitation is the
sole cause of the pain. More usually however,
there is partial relief of pain indicating
segmental facilitation combined with local
pathology.
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Combined cervical dysfunctions (C2/3, C5/6,
T2/3)
Often an isolated C5/6 dysfunction will not cause tennis elbow as the changes are subclinical, however, the same level of change when combined with other dysfunctions will produce a problem.
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Abduction subluxation of the ulnohumeral joint
The subluxation tends to push the radius distally, shifting the carpals ulnarly and limiting their ability to extend. The theory is that the proprioceptive feedback telling of a failure to extend and radially deviate caused increased activity in the extensor muscles and subsequent tendonitis. Examine the elbow for loss of the normal abduction end feel in both the osteokinematic and arthrokinematic. Treatment involves reducing the pathomechanical problem and treating the local pathology.
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Flexion carpal subluxation
This is basically the same mechanism as the ulnar subluxation but the dysfunction is in the wrist. Examine the wrist for the subluxation and treat it by manipulation.
Example of kinesio taping on the elbow
This content is provided courtesy of Jim Meadows and Swodeam Consulting .
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