IPHREHAB :TENNIS ELBOW TESTS AND EXAMINATION WITH CAUSES

IPHREHAB

TENNIS ELBOW TESTS ANS EXAMINATION WITH CAUSES

PHYSICAL EXAMINATION:

*point tenderness typically occurs over ECRB origin at the lateral epicondyle.

*tenderness may be more generalised over the common extensor wad insertion at the lateral epicondyle

*pain is often exacerbated by wrist extension against resistance with the forearm pronated

*elbow extension may be mildly limited

Mills test :

With this test, pain occurs over the lateral epicondyle when the wrist and fingers are completely flexed. This can be positive in tennis elbow case.

Maudsleys test:

The patient may feel pain on resisted extension of the middle finger at the MCP joint when the elbow is fully extended.

EVALUATION:

Note the sensory paresthesis in the superficial radial nerve distribution to rule out a radial tunnel syndrome.

Radial tunnel syndrome is the most common cause of refractory lateral pain and coexists with lateral epicondylitis in 10% of patients.

*Cervial nerve roots should be examined to rule out cervical radiculopathy .

OTHER CONDITIONS TO RULE OUT INCLUDES:

#bursitis of the bursa below the conjoined tendon,chronic irritation of the radiohumeral joint or capsule

#radiocapitellar chondromalacia or arthritis

#radial neck fracture

#panners disease

#little league elbow

#osteochondritis dissecans of the elbow

Tennis Elbow Causes 

Any repetitive motion of the wrist, including tennis, hedge clipping, excessive use of a hammer or screwdriver, painting, or any activity that requires excessive constant gripping or squeezing can cause the condition known as tennis elbow. 

IPHREHAB : TENNIS ELBOW OR LATERAL EPICONDYLITIS

IPHREHAB

What is Tennis Elbow ?

Tennis elbow is an injury to the muscles and tendons on the outside (lateral aspect) of the elbow that results from overuse or repetitive stress. The narrowing of the muscle bellies of the forearm as they merge into the tendons create highly focused stress where they insert into the bone of the elbow. If one hyper extends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The medical term is lateral epicondylitis. 

TENNIS ELBOW

LATERAL  EPICONDYLITIS (TENNIS ELBOW)

Lateral Epicondylitis is defined as a pathologic condition of the wrist extensor muscles at their origin on the lateral humeral epicondyle. The tendinous origin of the extensor carpi radialis brevis (ECRB) is the area of most pathologic change.

Changes can also be found in the musculotendinous structures of the extensor carpi radialis longus,extensor carpi ulnaris and extensor digitorum communis. Overuse or repetitive trauma in this area causes fibrosis and microtears in involved tissues.

Nirschl referred to the microtears and the vascular ingrowth of the involved tissues as angiofibroblastic hyperplasia. Degenerative process should be termed tendinosis.

Most patients with lateral epicondylitis are between the ages of 30 and 55 years and many have poorly conditioned muscles. 95% of tennis elbow occurs in non-tennis players. 10 to 15 % of regular tennis players experience tennis elbow symptoms of varying degree in their tennis lives.

 The most common cause in tennis players is a "late" mechanically poor backhand that places excess force across the extensor wad i.e. the elbow "leads" the arm.

Other contributing factors includes-

1. incorrect  grip size

2. string  tension

3. poor  racquet "dampening"

4. underlying  weak muscles of the shoulder,elbow,and arm

Tennis grips that are too small often exacerbate or cause tennis elbow.

History of repetitive flexion-extension or pronation-supination activity and overuse is obtained.

Causes of lateral epiconylitis:

#Tightly gripping a heavy briefcase is a very common cause.

#raking leaves

#baseball

#golfing

#gardening

#bowling 

IPHREHAB :NPTE BOOKS TO PREPARE

IPHREHAB

Complete Names of books Needed For NPTE

Important Books:

Sullivan guide

Blue Book

Kisner

Magee

Red guide

kendall

Norkins

Joint structure and function- by pamela k. levangie and cynthia c. norkins.(biomechanics book)(reference book)

Physical Therapy board review by michael dunway(practice question book)

NPTE review and study guide by o'sullivan and siegelman.(main book for NPTE .also called red guide)

Physical Rehabilitation Assessment and treatment by o'sullivan Schmitz(reference book)

orthopedic Physical assessment by David J. Magee (vvvvvvvv imp for special tests pictures and xray pics)

Blue book U can only get after taking 2 days course from www.therapyed.com or old from from some student.(take latest 4.0 version)

Muscle testing and function by ~ Florence Peterson Kendall (Author), Elizabeth Kendall mccreary(read the compensatory movements)

PTEXAM, Physical Therapist: The Complete Study Guide (Paperback) by Scott M. GIles.

Exams needed to be solved:

Peat 200 questions : This is the closest to NPTE

Micheal Dunaway 400 Ques

Sullivan guide 600 Ques

Blue book 200 Ques

Therapyed online Exam 200 Ques

Scott and Gills 800 Ques

IPHREHAB: NPTE TIPS FOR PTs

IPHREHAB

NPTE-Tips

Here are the few things that you need to know before appearing for NPTE:

What ever u read ,try to understand each and every word together with cramming it.

Do not put much time in reading whole of kisner and Magee.

The Special tests in maggee are very important but just concentrate on the ones given in RG. Special tests based questions are usually photo based.Focus on RG tests but see the pictures from magee.RG is the "mool mantra" to clear NPTE.If u are really thorough with it u can crack the exam easily.

The red sullivan is good for some reading...Read all PNF techniques thoroughly.

I wud like to mention one important thing as far as ANATOMY is concerned.Please don't go about reading all the origin insertion .....u r just expected to know the rough idea form which bone to where ,,,and nerve courses general idea.the nerve supply is EXTREMELY IMPORTANT!For this BB and RG charts are too good.

Blood supply is important,nerve supply Very imp and also the dermatomes n myotomes extremely imp.The blue book Charts are awesome.learn each and every word of it.Don't feel surprised if half of ur test is based on these!!

Biomechanics..I just did it frm RG n BB.Focus on Knee and shoulder joint.Examiner's fav!

Kisner....Basically concentrate on pictures of Joint mobilisation and Postures

UVR ,SWD,IR,LASER.... r omitted! Focus on currents.

All condts in RG n BB are imp for all the systems.Focus on other systems in BB.

Pharma from BB is IMPORTANT.

Don't refer to any other books for pathology n dermatology!Focus on wounds

Kendall...Do the ankle, knee n hip compensatory motions tables.Extremellllllllly Important!Pay spl attention.

KNEE....MOST FAVORITE TOPIC FOR EXAMINERS!

GAIT.....EVEN MORE FAVOURITE!!! Do all the tables in RG n BB

. really piss u off with this topic.I suggest to go thru this topic DAILY , learn them thoroughly each day of ur prep together with compensatory motions.BB Charts and RG charts are like " life line" for Gait questions.

-----------------------

X-rays: Study thru maggee pics ...don't focus much on it!

ECG:i think RG is good for this..Questions usually have ECG strips so my notes will help u.

Wheelchair,prosthetics,orthotics very imp.Learn daily,

Postures:Be good in this!

Study plan for NPTE

1st and 2 nd week:

Review guide(RG) and blue book (BB) reading

complete reading both these books by end of the 2 weeks or 3 weeks. Mark the Important stuff ,payspecial attention to the tables

Sunday: On the sunday of the 2nd week , take the 1 st practise test of the BB.

( do not take tension for getting a low score,ur just takin the test as a practise so that u understand the nature of the questns that are asked in the exam)PLEASE spend time in analyising your weak areas.Please!!!

3rd week: Again read RG AND BB but this time lil more in detail, (pay attention to values,tests,nerve supply etc etc)

Sunday: again take the test of RG( 3rd sunday)

4th week RG N BB reading( being thorough with .... tables ,nerves ,muscles actions,MMT , pay attention to small details) .

Sunday : take another test --3rd test

5th week : RG AND BB revision

sunday: The RG TEST

6th week and 7th week : Focus on your week areas and take other tests.

Happy preperations!

AND REGARDING WHAT I STUDIED FOR THE EXAM,

Don't be upset if u are not good in research.I just studied red guide and blue book..I did likliehood ratio from internet.do read the chart of values(u will get online).

FROM REDBOOK READ CERTAIN TOPICS LIKE SPINAL CORD INJURIES,ORTHOTICS,PROSTHETICS AND WHEEL CHAIR.

REVIEW GUIDE AND BLUE BOOK: Do EACH QUESTION PAPER as many times as u can, this will help you TO ANALYSE THE QUESTIONS VERY FAST IN THE MAIN EXAM.I did the same. Please read all the charts of bb ans rg daily.daily means daily.They are vvvvvvvvvvv imp for exam.

IPHREHAB : NPTE FOR PTs IN USA

IPHREHAB

If you are a Foreign PT (physiotherapist) seeking career in USA
Here is the process of starting your career as a physical therapist in USA:


1. Just sit quietly and give yourself sometime and think which STATE you are planning to work in as a PT.


2. Decided? Now let's move ahead.


3. Apply to one of the Credential evaluation agencies to find out if your education is equivalent to USA entry level education.


You can apply to one of these agencies depending upon the state you are interested in:-
a) www.fccpt.org
b) www.cgfns.org
c) www.ierf.org


FCCPT COVERS THE MAXIMUM NUMBER OF JURISDICTIONS.SO FOR LONG TERM APPLYING WITH THIS AGENCY IS BENEFICIAL.LIKE IF IN FUTURE YOU WANT TO APPLY FOR SOME OTHER STATE'S EVALUATION,THERE IS NO NEED OF REQUESTING YOUR DOCUMENTS AGAIN FROM YOUR ACADEMIC INSTITUTION, AS FCCPT KEEPS YOUR PAPERS WITH THEM FOR A LONG TIME.
IERF DOES NOT HAVE VISA SCREENING SERVICE SO THOSE WHO NEED WORK PERMIT OR H1, ITS BETTER TO GO FOR CGNFS OR FCCPT.


4) Credential evaluation can take a long time upto 6-7 months .All depends on the agency you choose and the time your academic institutions take to send over your documents to USA.(better use fedex account ) 


5)while you have applied for educational evaluation,don't waste time:- you have three choices:-


i) If u need H1,better start preparing for "TOEFL".And get done with it.The score requirements differ with states so better check with agencies not with state boards because TOEFL is required only for Visa Screening not for PT license.


ii) Few country PT always get some deficiency in general credits like INDIA.(i know this because I am an Indian).So giving few Clep exams won't hurt.i did the same.this will save time in future.Don't go for lab courses as you don't know which compulsory lab course will u get.So better opt for English.Science etc.


iii) Read the reference books for NPTE as u won't get time for them later.I mentioned in my earlier post regarding the reference books.


6) If u do not have a social security number u have to apply for a alternate identification number(AIN) which will b required when u register for the NPTE.This can be applied here:-
http://www.fsbpt.org/download/AINApp_20090105.pdf

7) Apply to required state board of education.And fill their application for PT License.
u can send them application even now as u apply to one of the agencies (fccpt,ierf,cgfns).they will again open a file for u and keep and as soon as they receive doc or report from the agency ,they will give you a green signal to appear for NPTE.this 7th step can differ a bit depending upon the state.


8) After TOEFL, start preparing for NPTE so that as soon as evaluation is complete and state board sends u approval letter ,u can apply to fsbpt for a ATT(approval to test).This will give a 2 months eligibility period starting frm around the date u apply,so apply for att only once sure of giving the exam within coming 2 months.
Also after this 2 months eligibility period u have to agian apply for another Att n pay the fees again.The site is www.fsbpt.org


5) Once Att letter is in ur hand register for a date with prometric.they have centres all around.u can choose which suits u according to the available day and date.And all the best for the exam.


So thats all ...the process looks very lengthy n confusing but dont worry...just apply for credential evaluation for now..the rest will take no time. In fact a few will be done while waiting for evaluation to be complete.
Have patience !


Hope this helps......