LATERAL EPICONDYLITIS

(TENNIS ELBOW)

tennis elbow

Wahyu Sita Wardani

1
 Data Base Identity
Name : Mrs. S
Age : 43 yo
Address : Surabaya
Occupation : Piano teacher
Status : Married
Religion : Christian

Patient was referred from orthopaedic

outpatient clinic with Left Tennis Elbow
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Chief Complain
Nyeri siku kiri

History of Present Illness

Pain of the left elbow has been felt since 1 month ago after
her left elbow hit the door.
Pain is felt as a dull pain, she described it as kemeng,
and it didnt radiate.
The pain is intermittent. It increase with activity such as
lifting her bag, usually containing her laptop and books, or
when sleeping on the left side and sometimes the pain
suddenly came while shes playing piano. VAS = 5
The pain was decreased by rest or taking analgesic drugs.
There was no numbness, tingling sensation and weakness
on her left hand

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 She was still able to do her daily housewife
activities such as cooking and cleaning but
sometimes feels pain.
She works as a private Piano Teacher for about
12 years. She usually teach 3-4 days a week.
With the duration for each course session is
about 1-2 hours.
At home she usually play piano too for about 15-
20 minutes a day

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History of Past Illness
History of prevous trauma (-)
No history of DM
No history of HT

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Physical Examination
General Status
CM, ambulatory independent, normal gait, right handed
domination
Body Weight : 50 Kg, Body height : 158 cm, BMI = 20,03 kg/m2
BP : 110/70 mmHg, HR : 72 x/minute, RR : 20 x/minute
Head and Neck : No Anemia, Icterus, Cyanosis, Dyspneu
Thorax : Cor : S1S2 sound, murmur -,
gallops -
Pulmo : vesicular/vesicular,
wheezing -/-, ronchi -/-
Abdomen : Meteorismus -
Liver / Spleen : unpalpable
Extremities : warm acral +/+, no oedema
 Physiatric Examination
Cervical ROM MMT
Flexion F (0-450) 5
Extension F (0-450) 5
Lateral Flexion F/F (0-450) 5/5
Rotation F/F (0-600) 5/5

Trunk ROM MMT

Flexion F(0-450 ) 5
Extension F (0-300) 5
Lateral Flexion F/F (0-350) 5/5
Rotation F/F (0-450) 5/5

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Shoulder ROM MMT
Flexion F/F (0-1800) 5/5
Extension F/F (0-800) 5/5
Abduction F/F (0-1800) 5/5
Adduction F/F (0-450) 5/5
Ext. Rotation F/F (0-450) 5/5
Int. Rotation F/F (0-550) 5/5
Elbow ROM MMT
Flexion F/F (0-1500) 5/5
Extension F/F (1500-0) 5/5
Forearm supination F/F (0-800) 5/5
Forearm pronation F/F (0-800) 5/5
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Wrist ROM MMT
Flexion F/F (0-800) 5/5
Extension F/F (0-700) 5/5- (pain)
Radial deviation F/F (0-200) 5/5
Ulnar deviation F/F (0-300) 5/5

Fingers ROM MMT

Flexion
MCP F/F (0-900) 5/5
PIP F/F (0-1000) 5/5
DIP F/F (0-900) 5/5
Extension F/F (0-450) 5/5- (pain)
Abduction F/F (0-200) 5/5
Adduction F/F (200-0) 5/5
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Thumb ROM MMT
Flexion
MCP F/F (0-500) 5/5
IP F/F (0-900) 5/5
Extension F/F (0-900) 5/5
Abduction F/F (0-500) 5/5
Adduction F/F (500-0) 5/5
Opposition 5/5

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Hip ROM MMT
Flexion F/F (0-1250) 5/5
Extension F/F (0-300) 5/5
Abduction F/F (0-450) 5/5
Adduction F/F (0-200) 5/5
Ext. Rotation F/F (0-800) 5/5
Int. Rotation F/F (0-800) 5/5

Knee ROM MMT

Flexion F/F (0-1350) 5/5
Extension F/F (1350-0) 5/5

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Ankle ROM MMT
Plantar Flexion F/F (0-450) 5/5
Dorsi Flexion F/F (0-300) 5/5
Inversion F/F (0-350) 5/5
Eversion F/F (0-250) 5/5
Toes ROM MMT
Flexion
MTP F/F (0-300) 5/5
IP F/F (0-500) 5/5
Extension F/F (0-800) 5/5

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Big Toe ROM MMT
Flexion
MTP F/F (0-250) 5/5
IP F/F (0-250) 5/5
Extension F/F (0-800) 5/5

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Neurological Examination

Cranial nerves I-XII : normal

Physiological Reflexes :
BPR +2/+2 KPR +2/+2
TPR +2/+2 APR +2/+2
Pathological Reflexes : Babinski -/- HT -/-
Sensory deficits :-

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Localize status : Right elbow
I : swelling -, redness -, deformity -
P : tender point at left lateral epicondyle of
humerus

Special test :
Compression test : -/-
Distraction test : -/-
Tinnel sign : -/-
Thomson test : -/+

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Diagnosis : Left Lateral Epicondylitis

Functional diagnosis :
Impairment : - Left Lateral epicondylitis
- Pain at left elbow
- Tender point at left lateral epicondyle of humerus
Disability : Difficult to lift heavy objects and playing piano
Handicapped : Disturbing her activity when teaching piano course

Problem List :
Surgical :-
Medical : Left Lateral Epicondylitis
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Rehabilitation medicine
R1 (Ambulation) : -
R2 (ADL) : -
R3 (Communication) : -
R4 (Social) : -
R5 (Psychological) : -
R6 (Vocational) : Pain when shes doing her job
activity as a piano teacher
R7 (Others) : Pain at left elbow (VAS 5)
Tender point at left epicondyle
of humerus

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Planning
Surgical : -
Medical : continue NSAID from orthopaedic outpatient clinic
Rehabilitation medicine :
PDx :-
PTx : USD at area of left elbow, Freq. 3MHz, continuous
mode, intensity 1 W/cm2, duration 10 min.
P.Mx : Clinically, VAS
P.Ed : HE / HEP
- avoid repetitive movement of the left wrist
- avoid lifting heavy objects with left hand
- icing
- Stretching and ROM exercise at home

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 Summary
Reporting a patient, 43 y.o woman, working as a
piano teacher, referred from orthopaedic
outpatient clinic with left tennis elbow
Chief Complain : Nyeri siku kiri
Pain of the left elbow has been felt since 1 month
ago after the left elbow hit the door. Pain
described as a dull pain, increase with such
activities as lifting bags and playing piano. The
pain decreased with rest and taking analgesic
drugs. There was no numbness, tingling sensation
nor weakness on her left hand.

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She was still able to do her daily activities but feels
pain.
From physical examination was found tender point
at left lateral epicondyle and Thomson test + at
the left elbow
We plan to treat it by giving USD at area of the
left elbow, avoid repetitive movement of the left
wrist, avoid lifting heavy objects with left hand,
icing, Stretching and ROM exercise at home

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THANK YOU

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