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CONDITION/DISORDER SYNONYMS

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  • Lateral tendon injury

  • Lateral tendonitis

  • Lateral humeral epicondylitis

  • Tennis elbow

  • Lateral tennis elbow

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ICD-9-CM CODE

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  • 726.32 Lateral epicondylitis

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ICD-10-CM CODE

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  • M77.10 Lateral epicondylitis, unspecified elbow

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PREFERRED PRACTICE PATTERN

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation1

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FIGURE 164-1

(A) Lateral view of the forearm, superficial (B) and deep (C) muscles of the posterior forearm. (From Morton DA, Foreman KB, Albertine KH. The Big Picture: Gross Anatomy. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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PATIENT PRESENTATION

A 42-year-old female has come to the physical therapy out-patient clinic for an evaluation of her right upper extremity. As a part of her initial history, the patient states that she is a police officer and an amateur bodybuilder. The patient states that the pain in her arm started suddenly and was noticeable when turning the ignition key of her police cruiser. She points to pain along the lateral aspect of her right elbow. She has point tenderness with palpation of area with increased pain in elbow with wrist and elbow extension. Imaging radiographs are normal. Physical inspection reveals that rubor and warmth are present in the muscle bellies of extensor digitorum and extensor carpi radialis longus.

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KEY FEATURES

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Description
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  • Tendinosis of wrist extensor tendons that attach at the lateral humeral epicondyle.2

  • Normal collagen response is disrupted by fibroblastic, immature vascular response and an incomplete reparative phase.

  • Early stages may display inflammatory or synovitic characteristics.

  • Later stages may demonstrate microtearing, tendon degeneration with or without calcification, or incomplete vascular response.

  • Pain in lateral elbow with resisted wrist extension and radial deviation with elbow extended.

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Essentials of Diagnosis
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  • Tendonitis of the elbow is rarely caused by acute trauma except in sports-related events, such as tennis.3

  • Usually affects middle-aged clients; aging process leads to decreased mucopolysaccharide chondroitin sulfate within tissues, making tendons less extensible.

  • Age-related tissue changes for tennis elbow appear in patients aged 35 years and older.

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General Considerations
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  • Tendinosis affecting the elbow is rarely acute unless by direct trauma (then considered tendonitis).

  • Pain usually is associated with activity, more so afterward.

  • Onset of pain is associated with wrist extension, elbow extension, and forearm pronation activities.

  • Direct blows to lateral epicondyle can initiate symptoms.2

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Demographics
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  • People aged 40 to 50 years4

  • Accounts for 7% of all sports injuries4

  • Males and females equally affected4

  • 75% of patients are symptomatic in their dominant arm4

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CLINICAL FINDINGS

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