The Elbow, Forearm, Wrist & Hand Injuries Epicondylitis (Medial & Lateral) & Carpal Tunnel Syndrome Annie Sullivan & Chris Vanaman

Lateral .vs. Medial Epicondylitis Lateral – “tennis elbow” Stemming from a backhand stroke involving overextending the wrist. Medial – “golfer/throwers elbow” May result from a number of different sport activities that require repeated forceful flexions of the wrist.

Anatomic Location Lateral – Lateral Epicondyle Extensor Carpi Radialis Brevis (ECRB) Outside of Elbow Medial – Medial Epicondyle Extensor Carpi Radialis Brevis (ECRB) Inside of Elbow

Causes of Epicondylitis Poor General Conditioning/Technique Overuse Jobs with Vigorous/Repetitive Use of the Forearm Muscle Painters Plumbers Carpenters Auto Workers Cooks Butchers

Signs/Symptoms of Epicondylitis Pain/burning on the outer part of the elbow Weak grip strength Inflammation & Swelling Pain increased with resisted wrist extension Pain usually begins as mild & slowly worsens over weeks & months. Increased pain noted with gripping handshake

Facts/Statistics about Epicondylitis Lateral Epicondylitis is one of the most common problems of the elbow occurring in sports. The annual incidence is 1-3% of the U.S. population. Tennis Elbow surgery is considered successful in 80-90% of patients. For the average person who develops a single- occurrence of tennis elbow, most symptoms will usually disappear between 9.6 and 12 months.

Care/Treatment/Prevention Rest or Watchful Waiting Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)/Medicines Physical Therapy (Rehabilitation) Counterforce Bracing/Brace

What is Carpal Tunnel Syndrome? Compression of the median nerve; located in the carpal tunnel. Carpal tunnel is formed in the wrist by the carpal bones and the transverse carpal ligament.

Causes Heredity Some people have smaller carpal tunnels Overuse Prolonged use of the hand can lead to CTS Ex. typing

Statistics The female to male ratio is 3:1 The peak age range for development of CTS is 45-60 years old Only 10% of patients are younger than 31 The incidence of CTS is 1-3 cases per 1000 subjects per year

Anatomy of the wrist Median nerve- feeling in palm side of the thumb, index finger, and long fingers Flexor tendons- bend the fingers *Both are affected by CTS

Stages of CTS Early- occasional pain only at night; fluids are redistributed to upper limbs while resting; tendency to flex wrists while resting which increases pressure Intermediary- more frequent symptoms and they occur during the day and night Advanced- symptoms are constantly present

Symptoms Numbness Tingling Pain in the hand Electric shock-like feeling Strange sensations traveling up the arm

Treatments Nonsurgical Bracing/splinting Medications Activity changes Steroids Surgical

Bracing/splinting Braces can be worn at night Reduces aggravation that may occur while the wrist is curled up during sleep Also can be worn during activities that may cause irritation of medial nerve

More Treatments Medications NSAIDS Activity Changes Change positions to reduce irritation; take breaks

Steroids May help alleviate pain but the pain may come back

Surgical Interventions Surgery is an option for those with severe symptoms Surgery will release the transverse ligament High initial success rates (>90%) Low complications Long term success rate is not very high (~60% after 5 years)

Epicondylitis Picture Sources http://b-reddy.org/2011/09/15/get-rid-of-inner-elbow-pain-aka-medial-epicondylitis-aka- golfer%E2%80%99s-elbow/ http://massagetherapy.careerpathblog.com/tag/tennis-elbow/ https://sinewtherapeutics.com/tennis-elbow/ http://www.bodyheal.com.au/blog/what-is-tennis-elbow-lateral-epicondylitis-treatment http://www.hays-nyc.com/services/plumbing-service-nyc/ http://thomaspaintservices.com/ http://www.oregonlive.com/business/index.ssf/2011/09/gm_united_auto_workers_agree_t.html http://www.eastpointehealthandfitness.com/press-articles/bid/44641/The-Team-at-Eastpointe- Chiropractic-Helps-Patient-Carl-Gentry-Keep-the-Music-Alive http://en.wikipedia.org/wiki/Aspirin http://www.betterbraces.com/elbow-braces/tennis-elbow-supports http://www.orthopodsurgeon.com/tenniselbow.html http://thomasbondphysio.blogspot.com/2013/02/medial-and-lateral-epicondylitis.html

Carpal Tunnel Syndrome Picture Sources http://vimeo.com/11785032 http://www.regenexx.com/2013/08/carpal-tunnel-surgery-recovery/ http://www.dme-direct.com/ossur-exoform-carpal-tunnel-wrist- brace http://www.carpal-tunnel-symptoms.com/nerve-glide-exercises.html http://trialx.com/curebyte/2011/05/21/clinical-trials-and-images-of- carpal-tunnel/