Case Study - Tennis elbow a real pain in the neck ! Mrs B is a 62 year old woman who presented forphysiotherapy with a history of right lateral elbowpain, which had arisen gradually without any significant cause. The pain was worse with gripping actions, such as holding pots or cups of tea, as well as reaching overhead and washing her hair. Mrs B also complained of associated right arm and shoulder pain extending into the neck, also aggravated by similar activities.
Thorough examination revealed Mrs B had clinicalsigns of tennis elbow, a common and painful condition that occurs secondary to inflammation and degeneration of the extensor carpi radialis brevis tendon in the elbow. This tendon attaches one of the main wrist extensor muscles to the lateral epicondyle (elbow) and is important in most manual tasks.
However, Mrs B also had clinical signs in her cervical spine that suggested that some of her symptoms may be arising from her neck. The fact that some of her aggravating activities involved movement of the shoulder and muscles of the neck and scapula supported this theory. These thought processes that physiotherapists use to determine the nature and extent of symptoms are collectively known as clinical reasoning.
After several weeks of treatment on the elbow with only moderate improvement, treatment altered to focus on the cervical spine. In particular, cervical traction was administered and Mrs B?s pain resolved completely within three sessions.
This example illustrates the complex nature of tennis elbow and how the cervical spine can refer pain to the elbow. Interestingly, most patients who suffer tennis elbow do not play tennis. The cervical spine is a common source of symptoms in this condition, but each individual case is different andneeds to be assessed thoroughly.
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