مرفق التنس - التهاب اللقيمة الوحشية - التهاب الكوع Tennis Elbow - Lateral Epicondylitis (subtitled)

Lateral Epicondylitis (Tennis Elbow) is an overuse injury leading to chronic tendinosis or, in some cases, chronic microtearing. This leads to pain on the outside of the elbow. Playing tennis is a possible cause of tennis elbow, but other activities can also put you at risk. Such as Baseball, Fencing and others. People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers and cooks. workers engaged in forceful activity using heavy tools can also develop tennis elbow. Pain or burning on the outer part of your elbow that may radiate into your forearm and wrist. Pain when twisting or bending your arm (for instance, to turn a doorknob or open a jar). Weakened grip when you try to hold items like a racquet, pen or shake someone’s hand. During the examination, he will apply gentle pressure to the lateral epicondyle, checking for pain and tenderness. Cozen’s Test: The affected elbow is stabilized at 90degrees flexion, forearm pronated (palm down), hand clenched and in radial deviation. The patient attempts to extend the wrist (lift the hand up) while the examiner resists the movement. Pain at the lateral epicondyle indicates a positive test for lateral epicondylitis Maudsley’s Test: The examiner places their finger over the tip of the patient’s middle finger and resists finger extension. Pain over the lateral epicondyle is positive for tennis elbow Mill’s Test: The examiner palpates the lateral epicondyle, pronates the patient’s forearm, fully flexes the wrist and extends the elbow. Pain over the lateral epicondyle indicates tennis elbow up to 95% success rate with nonoperative treatment, but patience is required Patients should avoid activities that exacerbate symptoms for several weeks. braces may provide benefit during the first six weeks following injury. These braces are placed on the forearm approximately 6 to 10 centimeters distal to the elbow joint. counter force bracing may reduce tendon and muscle strain at the origin of the forearm extensor muscles, thereby relieving pain and improving function. Some clinicians use volar splints to reduce activity of the wrist extensors and flexors during particularly painful episodes of epicondylitis. We do not recommend splinting except in the most severe cases People with severe pain may have the elbow immobilized in a sling at a 90-degree angle, although the elbow should not be immobilized for prolonged periods. Taking nonsteroidal anti-inflammatory (NSAIDs) to help with pain and swelling if not contraindicated. Physical therapy exercises can strengthen forearm muscles and your grip. Massage, ultrasound or other muscle-stimulating techniques may help to reduce pain and improve function. Extracorporeal shock wave therapy sends sound waves to the elbow that promotes the body's natural healing processes and can effectively relieve the pain and functional impairment. Steroid injection temporarily relieves pain and inflammation. These injections must be placed in the correct area, which is why they are injected under ultrasound guidance. up to 3 injections in the same area, with at least a 3- to 6-month gap between them. Platelet-rich plasma (PRP) therapy: Platelets are tiny cell fragments in your blood contain growth factors that stimulate tissue repair and aid healing. During a (PRP) therapy injection, your provider removes a small amount of blood and separates platelets from other blood cells. Then they inject the concentrated platelets into the injured area under ultrasound guidance. Autologous blood injections — In refractory cases of epicondylitis, another treatment option involves injecting a sample of the patient's blood under ultrasound guidance into the site of chronic elbow tendinosis. acupuncture may provide some short-term relief, but there is no evidence of sustained benefit. Botulinum injection — botulinum toxin A injection may improve pain over a 3-month period in some patients with lateral epicondylitis Ultrasound-guided percutaneous needle tenotomy: In this procedure, under ultrasound guidance, a doctor inserts a special needle through your skin and into the damaged portion of the tendon. Ultrasonic energy vibrates the needle so swiftly that the damaged tissue liquefies and can be suctioned out. Surgical referral is generally reserved for patients with severe symptoms who do not improve despite careful compliance with a well-designed physical therapy program for greater than 6 months. Following surgery, your arm may be immobilized temporarily with a splint. About 1 week later, the sutures and splint are removed. After the splint is removed, exercises are started to stretch the elbow and restore flexibility. Light, gradual strengthening exercises are started about 2 months after surgery. you can return to athletic activity usually 4 to 6 months after surgery.