Examination (easy to diagnose) - Bradford VTS
Tennis ElbowRepetitive overuse of common extensor tendon – where it attaches to the distal humerus. Symptoms can last for 2y. Sharp pain. Examination (easy to diagnose)Tender lateral epicondyle ++Pain on resisted wrist extension (with elbow in full extension)Pain on passive wrist flexion (with elbow in full extension)DifferentialsRadial Tunnel Syndrome: if the pain is more distal (3-4cm distal and ant to epicondyle), and more dull in nature and often at night, think Radial tunnel syndrome (compression fo the post. Interosseous nerve) – refer for EMG.Olecranon Bursitis: pain at back and localised swelling there.ManagementRest alone – resolution in 1y in 90%Modification of activities – e.g. if lifting – turn palm upwards to shift strain to the wrist flexor originNSAIDs – topical or oral – only improve symptomsSteroid Injections – short term not long term improvementExercises – reduce symptoms at 12 weeks!Orthoses – elbow braces & wrist splinting might help – puts extensor muscles in a position of restSurgery – success rates variableExercises: see this website:ashcroftsurgery.co.uk/pils/tennis-elbow DeQuervain’s Tenosynovitis (DQT)Inflammation of tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB) asa result of repetitive overuse. Common more in women – esp mothers 6-12m post partum – lifting their babies. Also, computer use, cooking, cleaning. DQT also associated with RhA – look for hand deformity/swelling – is it a signal of RhA???Examination (easy to diagnose)Tenderness at radial styloid/first dorsal compartment of wrist (just before anatomical snuff box)Finkelstein’s test – fist with thumb inside fingers; then passive ulnar deviation of wrist = pain ++Differential OA of 1st MCPJ –often have Heberden’s nodes too. Grind test: move 1st MCPJ in a circle and loading it with gentle force pain in OA but not DQT. Finkelstein test can be positive in OA too. 20% people over age 55 have thumb base OA. 3m + duration, morning stiffness >30min. Don’t need x-rays (correlation poor)ManagementRest - resolves many; apply cold packs. Modification of activities – avoid thumb wrist movements. Topical/oral NSAIDs. Steroid injection >80% cure rate. Orthoses – thumb splint from OTC. Phsyio. Surgery – variable results, so avoid. ................
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