Transcript Lateral Epicondylitis

Work Related Musculoskeletal
Disorders
Dr. Majid Golabadi
Occupational Medicine Specialist
Isfahan University of Medical Sciences
Job Risk Factors
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Repetition
Force
Awkward posture
Contact stress
Vibration
Upper Extremity Disorders
The Most Important Disorders
• Shoulder:
• Rotator cuff tendinitis
• Bicipital tendinitis
• Elbow:
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Lateral Epicondylitis
Medial Epicondylitis
Olecranon Bursitis
Cubital Tunnel Syndrome
• Wrist:
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Carpal tunnel syndrome
DeQuervain disease
Ganglion cyst
Trigger wrist
• Hand:
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Guyon`s canal syndrome
Hypothenar hammer syndrome
Trigger finger
Trigger thumb
Occupational hand cramp
Lateral Epicondylitis
(Tennis Elbow)
Lateral Epicondylitis
(Tennis Elbow)
 Inflammation, at the muscular
origin of the extensor carpi
radialis brevis (ECRB).
 the most common overuse injury
of the elbow
 up to 10 times more frequently
than medial epicondylitis
 most often occurs between the
third and fifth decades of life.
Ergonomic Stressors
• Frequent lifting
• Repetitive wrist dorsiflexion
with force
• Sustained power gripping.
• Repetitive forearm supination
• Sudden elbow extension
• Tool use, shaking hand,
twisting movement
Clinical Presentations
 lateral elbow pain of gradual onset.
 pain generally increases with
activity
 Picking up a cup of coffee or a gallon of
milk
 Heavy lifting
 Gripping
 Pain may be present at night.
 Symptoms are typically unilateral.
Physical Examination
localized tenderness to palpation just distal and anterior to the lateral
epicondyle.
The combination of lateral epicondylar pain on palpation plus pain on
resisted wrist extension is highly suggestive of the diagnosis of lateral
epicondylitis.
Presumptive Diagnosis Requires:
• Local tenderness directly over the lateral
epicondyle
• Pain aggravated by resisted wrist extension and
radial deviation
• Pain aggravated by strong gripping
• Normal elbow range of motion
Paraclinical Testing
• No specific test is required
Splints for Tennis Elbow
Carpal Tunnel Syndrome
• Carpal tunnel syndrome is a traumatic or pressure
neuropathy of the median nerve in the wrist
• The most common entrapment neuropathy in the body
• Compression of the median nerve as it passes through the
carpal tunnel
• Overall prevalence is 2.7%
• Is more common in women and between ages 40 to 60
years
Etiology
Work Related Risk Factors
Occupations that require Repetitive
Flexion and extension of the fingers and
wrist
Symptoms
• Paresthesias in the median nerve distribution,
gradually and spontaneously
• With progression: pain, numbness, tingling and
burning
• In more progressed cases: Reduced force, Skin
sensory deficit and Thenar Atrophy
Diagnosis
• History:
Night-time and morning symptoms, sometimes
occurring with driving, and relief by shaking or
movement (Flick sign)
• Intermittent Nocturnal Brachalgia
• Clumsiness
• Rule out of systemic causes
Physical Exam:
• Phalen’s Test and Tinnel’s sign
• Two-Point Discrimination Test
• thumb abduction
• thumb opposition
• pinch movements
Phalen Test
Tinnel sign
• Electrodiagnostic studies: EMG/NCV
confirm diagnosis
• Thenar weakness should warrant full EMG
studies
Treatment
1- 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
Surgery indications
• Progressive symptoms
• Persistent symptoms
• Thenar Atrophy
• EMG abnormalities
De Quervain’s Disease
De Quervain’s Disease
• Inflammation of the tendon sheath of the extensor
pollicis brevis and abductor pollicis longus
• Combination of Tendonitis and Tenosynovitis.
• In individuals between 30 and 50 years of age and
is ten times more prevalent among women than
men
• May be caused by OVER USE of thumb, like
repetitive work and forceful gripping
Symptoms
• pain at the base of the thumb.
• swelling
Differential diagnosis
• Old nonunion of navicular bone
• Osteoartritis of first carpometacarpal joint
Finkelstein test
Treatment
• Modifying hand activity
• Immubilization of thumb (3-6 weeks)
• NSAIDs
• Local Injection of Lidocain-triamcinolone into
tendon sheat (Standard Treatment)
• Surgical decompression
Trigger Finger
• Stenosing tenosinovitis of the flexor tendon of
the finger
• Painful snap or jerking movements in PIP
• Collapse the joint suddenly like a trigger
• Usually associated with using tools that have
handles with hard or sharp edges.
• Trauma,
• Rheumatoid arthritis,
• CTS
Differential diagnosis
• De Qurvein
• Dupuytren Contractures
Trauma, liver diseases, Alcohol Abuse
Dupuytren Contractures
Treatment
• Local Injection of Lidocain-triamcinolone into
tendon sheet (Standard Treatment)
• Surgical decompression
Osteoarthritis of the first
carpometacarpal joint
• In 25% of women older than 55 years
• Unknown cause
• Pain at the base of thumb when grasping
• Squaring of the base of thumb
• Diagnosis with radiographs
Tratment
• Avoid repetitive painful activities
• Immobilization
• NSAIDs
• Arthroplasty or arthrodesis
Scaphoid Fractures
• Occur in younger people
• Pain at the base of the thumb or wrist pain
• Tenderness of the tuberosity of scaphoid
• PA, Lateral and Scaphoid view Ragiographs
• MRI or Bone Scan
Treatment
• Nondisplaced
12 weaks immobilization
• Displased
Open reduction and Internal Fixation
Mallet Finger
• Disruption of extensor tendon at the distal
interphalangial (DIP) joint
Some Useful Tests
Apley Scratch Test
• Kyphosis 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.
Straight Leg Raise
SLR
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 pain
Sensitivity 91%
Specificity 26 %
Crossed Straight
Leg Raise
(Crossed SLR)
Examiner raises straight leg (30 to 60
degrees) eliciting radicular pain on
opposite side.
Sensitivity 25%
Specificity 90-97%
Reverse 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 irritation
Sensitivity ?
Specificity ?
Duck Walk Test
Knee Deformities