6Lateral Epicondylitis (Tennis Elbow) Inflammation, at the muscular origin of the extensor carpi radialis brevis (ECRB).the most common overuse injury of the elbowup to 10 times more frequently than medial epicondylitismost often occurs between the third and fifth decades of life.
8Ergonomic Stressors Frequent lifting Repetitive wrist dorsiflexion with forceSustained power gripping.Repetitive forearm supinationSudden elbow extensionTool use, shaking hand, twisting movement
9Clinical Presentations lateral elbow pain of gradual onset.pain generally increases with activityPicking up a cup of coffee or a gallon of milkHeavy liftingGrippingPain may be present at night.Symptoms are typically unilateral.
10Physical Examinationlocalized tenderness to palpation just distal and anterior to the lateral epicondyle.
12Presumptive Diagnosis Requires: Local tenderness directly over the lateral epicondylePain aggravated by resisted wrist extension and radial deviationPain aggravated by strong grippingNormal elbow range of motion
13Paraclinical TestingNo specific test is required
18Carpal tunnel syndrome is a traumatic or pressure neuropathy of the median nerve in the wrist The most common entrapment neuropathy in the bodyCompression of the median nerve as it passes through the carpal tunnelOverall prevalence is 2.7%Is more common in women and between ages 40 to 60 years
24SymptomsParesthesias in the median nerve distribution, gradually and spontaneouslyWith progression: pain, numbness, tingling and burningIn more progressed cases: Reduced force, Skin sensory deficit and Thenar Atrophy
25DiagnosisHistory:Night-time and morning symptoms, sometimes occurring with driving, and relief by shaking or movement (Flick sign)Intermittent Nocturnal BrachalgiaClumsinessRule out of systemic causes
26Physical Exam:Phalen’s Test and Tinnel’s signTwo-Point Discrimination Testthumb abductionthumb oppositionpinch movements
29Electrodiagnostic studies: EMG/NCV confirm diagnosisThenar weakness should warrant full EMG studies
30Treatment1- Treatment of associated conditions 2- Splinting the wrist in a neutral position at night and during the day . For 2 to 4 weeks Job task modification is often critical in this phase 3- Corticosteroid injection into the carpal tunnel 4- Surgery. After 3 month of conservative treatment
33De Quervain’s DiseaseInflammation of the tendon sheath of the extensor pollicis brevis and abductor pollicis longusCombination of Tendonitis and Tenosynovitis.In individuals between 30 and 50 years of age and is ten times more prevalent among women than menMay be caused by OVER USE of thumb, like repetitive work and forceful gripping
34Symptoms pain at the base of the thumb. swelling Differential diagnosisOld nonunion of navicular boneOsteoartritis of first carpometacarpal joint
38Stenosing tenosinovitis of the flexor tendon of the finger Painful snap or jerking movements in PIPCollapse the joint suddenly like a triggerUsually associated with using tools that have handles with hard or sharp edges.
57Kyphosis is excessive curvature of the spine in the sagittal (A-P) plane. The normal back has 20° to 45° of curvature in the upper back, and anything in excess of 45° is called kyphosis.Scoliosis is abnormal curvature of the spine in the coronal (lateral) plane. Scoliosis of between 10° and 20° is called mild. Less than 10° is postural variation.Lordosis or hyperlordosis is excessive curving of the lower spine and is often associated with scoliosis or kyphosis.
58Straight Leg Raise SLR Sensitivity 91% Specificity 26 % Examiner raises straight leg (30 to 60 degrees) eliciting radicular pain on same side (Lasegue Sign). Then lowers leg until pain goes away, the foot is then dorsiflexed causing return of painSensitivity 91%Specificity 26 %Consider Trendelenberg for Hip abductor weakness (L5) Hip extension for S1; short squat/getting out of chair (L4)
59Crossed Straight Leg Raise (Crossed SLR)Examiner raises straight leg (30 to 60 degrees) eliciting radicular pain on opposite side.Sensitivity 25%Specificity 90-97%Consider Trendelenberg for Hip abductor weakness (L5) Hip extension for S1; short squat/getting out of chair (L4)
60Reverse Straight Leg Raise (Reverse SLR)Patient is prone, examiner raises straight leg (30 to 60 degrees) –pain radiating to anterior thigh indicative of L3-L4 root irritationSensitivity ?Specificity ?Consider Trendelenberg for Hip abductor weakness (L5) Hip extension for S1; short squat/getting out of chair (L4)