Case Study: Lateral Epicondylitis

Case Study: Lateral Epicondylitis

The following case study gives you an idea of what treatments may be considered for this patient. This is a brief overview. Any CPD or case study for university would require much more depth and must be evidence based and demonstrate clear clinical reasoning. Many examples of these can be found through Pubmed and these should (alongside university guidelines)  be used as your outline for graded work.

Introduction

A 56 year old gentleman presented with a four month history of right lateral elbow pain. He reports a constant dull ache, VAS 3-5/10 which can be tender ++ if he touches the elbow. Symptoms were insidious in onset and have been gradually worsening. He works nights on road maintenance which involves some driving but mostly putting cones out onto motorways. He reports no pins and needles or numbness however does report pain that travels into the posterior aspect of the wrist if he does not rest. He has visited his GP several times who has advised NSAID’s and is keen to use a corticosteriod injection to settle his pain. Pain is worse in the early hours of the morning (following a night shift). He has no red flags, other PMH or hobbies. He is right handed.

 

Clinical Impression

The findings of the objective assessment fitted with lateral epicondylitis. There was tenderness on the common extensor origin which reproduced pain into the wrist which was described by the patent as the ‘same pain’ that he usually experiences. He demonstrated a positive Cozen’s and positive Maudsley’s test. There were several trigger point sitting with the wrist extensors. Elbow ROM was full however there was reduced strength of wrist extension (4/5) and grip 70% compared to left. He had full AROM of the cervical spine.
Right ULTT median (negative), radial (positive with 30 degrees shoulder abduction), ulnar (negative).

Treatment goals

  • Treatment goals were discussed and formulated with the patient.
  • Reduce of lateral elbow pain.
  • Increase strength of the wrist extensors.
  • Complete a 5 hour shift before onset of pain.
  • Improve function

Treatment Plan (“Tool box”)

  • Contraindications considered (ie aggressive manual therapy for older patients may need to be avoided if an X-Ray has not be taken/OA is still a differential diagnosis )
  • Explanation of ¬†pathology and therefore self management strategies.
  • Advice: Training Errors/Pacing/Avoiding aggravating positions/ Using opposite arm where possible.
  • Mobilisation with movement
  • Stretches
  • Tens
  • Ultrasound
  • Cyrotherapy
  • Taping
  • Eccentric loading
  • Acupuncture
  • Deep transverse frictions to CEO.
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