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 : OBESITY ETIOLOGY

IPHREHAB

OBESITY 


AETIOLOGY
Obesity is a heterogeneous group of disorders.
Causes of obesity remain elusive 
At one level, the pathophysiology of obesity seems simple: a chronic excess of nutrient intake relative to the level of energy expenditure. 
Complexity of the neuroendocrine and metabolic systems  has been difficult to quantitate

GENES

Obesity is commonly seen in families.

Inheritance is usually not Mendelian,

Adoptees usually resemble their biologic rather than adoptive parents with respect to obesity

Likewise, identical twins have very similar BMIs whether reared together or apart, and their BMIs are much more strongly correlated

ENVIRONMENTS

It plays a key role in obesity, 

Famine prevents obesity in even the most obesity-prone individual. 

Recent increase in the prevalence of obesity in the United States is due to environments

Cultural factors are also important. Easy availability and composition of the diet 

Decreased physical activity. 

In industrial societies, obesity is more common among poor women, whereas in underdeveloped countries, wealthier women are more often obese. 

In children, obesity correlates to some degree with time spent watching television.

High-fat diets may promote obesity, as may diets rich in simple carbohydrates. 

CAUSES OF OBESITY

Cushing's Syndrome  Although obese patients commonly have central obesity, hypertension, and glucose intolerance

Hypothyroidism should be considered when evaluating obesity, but it is an uncommon cause

Insulinoma  Patients with insulinoma often gain weight to avoid hypoglycemia

Craniopharyngioma and Other Disorders Involving the Hypothalamus  

Tumors, trauma, or inflammation, hypothalamic dysfunction of systems controlling satiety, hunger, and energy expenditure can cause varying degrees of obesity

Leptin in Typical Obesity

The vast majority of obese people have increased leptin levels but do not have mutations of either leptin or its receptor.

"leptin resistance." Data suggesting that some individuals produce less leptin per unit fat mass than others or have a form of relative leptin deficiency that predisposes to obesity