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Old 02-26-2009, 03:57 PM   #11
Dan Ricciardi
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Re: My Sports Med Dr Advice on Tennis elbow

Camille how long did yours take to go away?
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Old 02-26-2009, 07:03 PM   #12
Steven Low
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Re: My Sports Med Dr Advice on Tennis elbow

Quote:
Originally Posted by Mark Martinez View Post
Our PT here gave me a recipe for a nice cold pack that stays malleable versus solid.
I haven't actually tried it. So, I don't know how well it works.

- 50/50 water & isopropyl alcohol mixture placed in a freezer bag
- Freeze a couple of hours and presto!
- Refreeze, as needed
I have an Empi ice pack... they are malleable below freezing.

But that works I guess, hah.


Quote:
Originally Posted by Dan Ricciardi View Post
Camille how long did yours take to go away?
This depends on how bad you aggravated it. Some can go away in weeks.. some takes months.. and some takes years.. heh.

If you have some chronic pain that hurts all the time it will probably be months to years. If you're just getting pain, probably weeks if not less... otherwise, anywhere in between.
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Old 02-26-2009, 07:10 PM   #13
Camille Lore
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Re: My Sports Med Dr Advice on Tennis elbow

I'd guess about 2 weeks at the most once I did the ice and massages. It was pretty fast compared to how long I had it.
I had it for a good few months before that and it wouldn't go away.
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Old 02-26-2009, 07:11 PM   #14
Camille Lore
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Re: My Sports Med Dr Advice on Tennis elbow

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Originally Posted by Dan Ricciardi View Post
Camille, Yes I have started ice massage today and it really seems to help... the only hard part is slowing down for long enough to sit there and do it ( 2 little kids and FT job)

Mark- I have seen a similar recipe elsewhere but haven't actually used it. I will give it a try when the kids go to bed.
When it hurts, you know you're on the right spot. Hurts, but feels good at the same time.
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Old 02-27-2009, 08:22 AM   #15
Jake Thompson
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Re: My Sports Med Dr Advice on Tennis elbow

Dan, On short notice and limited access to web due to work restrictions here is what I have. Not a dislocation, more of a subluxation/positional fault situation. Enough to bung up (highly technical term) the movement. I pulled some info off the internet for you. Learned the technique from Jim Meadows, 2nd link, and has worked with several (50+) patients. Even those that have had multiple injections along with formal PT (RICE, US, massage, eccentrics) with no improvement. Hope this answers your ?s.

http://jmmtonline.com/past/vol14no1.php

swodeam.com/technique/tennisElbow.php

Abducted Ulna
Probably one of the most common examples of forearm bone misalignment that can elicit injury and pain over the wrist extensors as well as the lateral epicondyle is the abduction of the ulna resulting from ulnohumeral subluxation (Meadows, 2006). In this circumstance the proximal ulna separates from the proximal radius and the distal ulna approximates the distal radius. This condition is a positional fault of the elbow complex triggering contractile element pathology of the common extensor bundle (Miller, 2000).

What is the possible consequence of the ulnohumeral joint subluxation? Meadows clearly explains this in his discourse, “Abduction subluxation of the ulnohumeral joint results in the hand drifting into ulna deviation with subsequent loss of extension and radial deviation. The theory goes that the abnormal proprioception from the wrist due to the hypomobility leads to excessively forceful contractions of the radial extensors and deviators and subsequent overuse. Wrist hypomobility directly results in the same problem”. Again the concept goes back to fatiguing and overuse of the extensor muscles.

Functional Implication
Based from the biomechanical factors stated above what can we expect from patients functionally? If we are talking about lateral epicondylalgia brought about by cumulative stress over the extensors or peri-articular damages or ulnohumeral malalignment, we can expect that pain will be more pronounced during reaching and grasping heavy objects. Reaching, grasping, and manipulation of heavy objects require patients to exert more force from the muscles being discussed (especially during power grasp) thus we further elicit pain over the area. According to Castiello (2005) heavier objects need to be grasped more accurately and with a larger grip compared to lighter objects. Because of this, compensations can be observed during reaching and grasping.

The transport mechanism of reaching and grasping is composed of four phases. The preparation, acceleration, deceleration, and the stabilization phase. The “preparation” phase is the stage when the postural muscles are activated even before the reaching process has occurred. Here the trunk muscles as well as the leg muscles (during standing) contract to maintain balance in anticipation of its alteration during the arm motion. Also in this phase, the antigravity shoulder muscles contract to raise the upper extremity against gravity. The “acceleration” phase comes after the previous phase. In this stage the agonist muscles responsible for advancing the arms contract. Some of these muscles are the elbow extensors and shoulder flexors. These muscles are responsible in the sudden increase in the speed of the extremity as it approaches the target. However this does not last long. It only constitutes one-third of the whole reach. This will be immediately followed by the “deceleration” phase. During this phase the antagonist muscles slow down the reaching process for the purpose of ensuring accuracy. If the exact length of the reach has been achieved, the agonist and antagonist muscles coactivate to ensure stability of the extremity. This is what we call the “stabilization” phase.

Patients having pain over the lateral elbow usually would be apprehensive and slow (to become more accurate) in moving their affected upper limbs as a whole. They tend to guard the limbs and keep them closer to the body. This situation then results to more trunk motions in order to compensate and bring the limbs nearer to the objects which are to be manipulated. Aside from this we could also observe the forearm positioning among these patients once they grasp and manipulate heavy loads. Usually forearms are supinated among these patients. The reason for this is that forearm pronation can aggravate the pain being perceived by the patients.

In this scenario we can observe alterations in the normal reaching process. During the “preparation” phase the shoulder movement has been limited as the individuals try to keep the arm close to the trunk. We can also note that the “deceleration” phase has dominated if not completely been superimposed over the “acceleration” phase. And coactivation of the muscles can be observed to weaken due to the pain felt by the individuals as they perform grasping activities.

If lateral epicondylalgia is coupled with neurological affectation, not only sensory disturbances are to be expected. As what has been said earlier, if C5-C6 nerve roots are affected, we can expect weakness of the muscles they innervate (myotomes) especially the elbow flexors and the wrist extensors. In addition we can also expect limited neck motions direction of which depends on the laterality of the nerve root impingement. And thus when the neck moves the trunk also moves to provide greater range of motions for the body as a whole. Even overhead activities are affected and become more difficult. For example, a patient reaches overhead with shoulder (ipsilateral to the affected side) abducted, the nerve roots will be further irritated and still mimicking pain on the neck and on the lateral epicondyle.
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