Medial Epicondylitis Treatment Exercises

medial epicondylitis treatment exercises 1
impression medial epicondylitis treatment exercises 1

Medial Epicondylitis Treatment Exercises

DISCUSSIONThe eccentric exercise program introduced in this study appears to be an effective method of treating chronic medial epicondylosis. DASH scores and Sports module of the DASH were markedly improved with the addition of an eccentric wrist flexor exercise to standard physical therapy interventions. This novel exercise, using an inexpensive rubber bar, provides a practical means of adding isolated eccentric training to the treatment of chronic medial epicondylosis. A prescription of 3 sets of 15 repetitions daily for approximately 6 weeks appeared to be an effective treatment in the majority of patients who had already failed a previous intervention for this disorder.There are many different approaches to the treatment of chronic medial epicondylosis, such as electrophysical modalities,3 corticosteroid injections,4 exercise therapy and mobilization,5 low level laser therapy,6 repetitive low‐energy shockwave treatment,7 autologous blood injection.8 These are commonly provided independently from or as part of standard physical therapy care. Compared to isolated eccentric strength training, treatments such as low‐level laser therapy, shockwave therapy, corticosteroid injections or autologous blood injection, require direct medical supervision and in some cases have significant side effects. While the efficacy of isolated eccentric training for the treatment of tendinopathies in various joints has been clearly established10 ‐15 the additional benefit of this treatment for medial epicondylopathy is that it can be performed as part of a home program and it does not involve continued medical supervision. Not only does this provide a cost benefit, but treatment dosage is not limited by the patient having to come to a clinic or needing direct supervision.With respect to eccentric training for chronic medial epicondylosis, The authors’ of the current study are unaware of a single study examining the effect of eccentric training for medial epicondylosis. However, for lateral epicondylosis, Croisier et al14 and Tyler et al15 were able to show significant improvements using isokinetic eccentric wrist extensor training and a home eccentric flexbar program, respectively. The subjects in these studies were not ones that had failed previous treatments, unlike those enrolled in the current study. Due to the lack of incidence and prevalence of this pathology the authors’ chose not to design a prospective randomized trial as has been utilized in lateral epicondylosis studies. A limitation of the current study is that the effectiveness of the treatment cannot be attributed directly to the use of eccentric strengthening because there was no control group and other treatment techniques were being used simultaneously. Other limitations include the patient population included various mechanisms of injury; and that the failed treatments were from many different clinicians using multiple treatment methods.The use of patients who have failed a previous treatment intervention represents what is often encountered in clinical practice and may even be considered a “quasi control”. A limitation of the present study may be the small sample size. However, based on previous work8,15 it was estimated that 20 patients would be sufficient to detect a 40% improvement in DASH score at p<0.05 with 80% power and this number of enrolled patients was achieved.The average duration of treatment was approximately six weeks with the average number of physical therapy visits being 12. It remains to seen if isolated eccentrics alone without the addition of supervised physical therapy has the same clinical effects. Additionally, given that the follow‐up period was only six weeks after the initiation of treatment and that medial epicondylosis has a high recurrence rate, the current results should be viewed as evidence for short‐term efficacy of the addition of eccentric strengthening to a traditional physical therapy intervention. It remains to be determined if this treatment approach provides similar efficacy in the long term.A search of the literature revealed a paucity of quality studies examining the efficacy of treatments for medial epicondyle tendinopathy. In two published systematic reviews attempting to examine treatment effectiveness of interventions for medial epipcondylosis their authors found no studies meeting their inclusion criteria.3,5 A combination of dry needling and ultrasound guided autologous blood injection has been shown to decrease pain measured by visual analog scale (VAS) and modified Nirshl scores, but had a small a sample size of 20 similar to the current study.8 There is some evidence to suggest the use of low level laser therapy in the treatment of medial epicodylitis.6 Low level energy shock wave therapy for the treatment of chronic medial tendinopathy was found to offer poor results7 and there were long term benefits reported from a local injection of methylprednisolone.4 Given the inconsistent outcomes for patients previously treated with chronic medial epicondylosis the addition of isolated eccentrics seems promising based on the results of the current study.
medial epicondylitis treatment exercises 1

Medial Epicondylitis Treatment Exercises

Although epicondylitis means there is an inflammation, there is some controversy with this pathology. The pathologic process does not involve bony inflammation. Histologically it has been shown that medial epicondylitis is the result of microtearing in the tendon that isn’t fully relapsed (=To fall or slide back into a former state). Some physical therapists prefer the term tendonosis instead of epicondylitis. Another terminology for this condition is epicondylalgia, referring to pain rather than inflammation. Most of the time, golfer’s elbow is not caused by inflammation. Rather, it is a problem within the cells of the tendon. In tendonosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers and fiber separation by increased mucoid ground substance. There can also be an increased prominence of cells and vascular spaces and focal necrosis or calcification. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue. The tendon changes from a white, glistening and firm surface to a dull-apearing, slightly brown and soft surface. As medial epicondylitis is a tendonosis of the flexor group tendons attached to the medial epicondyle of the humerus, the most sensitive region will be located near the origin of the wrist flexor group.The patient usually complains about pain of the elbow distal to the medial epicondyle of the humerus with radiation up and down the arm, most common on the ulnar side of the forearm, the wrist and occasionally in the fingers .Local tenderness over the medial epicondyle and the conjoined tendon of the flexor group, without evidence of swelling or erythema, are also characteristics that can occur. Other symptoms are stiffness of the elbow, weakness in the hand and the wrist and a numb or tingling feeling in the fingers (mostly ring and little finger).
medial epicondylitis treatment exercises 2

Medial Epicondylitis Treatment Exercises

Medial epicondylitis has a lower incidence than lateral epicondylitis (tennis elbow), with the former containing only 9 to 20% of all epicondylitis diagnoses. The ‘golfer’s elbow’ and ‘pitcher’s elbow’ are synonyms. The pathology occurs in baseball pitchers as a result of high-energy valgus forces created by the overhead throw. It has also been reported with tennis, bowling, archery, weightlifting, javelin throwing, racquetball and american football. However 90 to 95% of all cases do not involve sportsmen . Because chronic repetitive concentric or eccentric contractile loading of the wrist flexors and pronator are the most common etiology, occupations such as carpentry, plumbing and meat cutting have also been implicated. The pathology may also be produced by sudden violence to these tendons in a single traumatic event. In many cases trauma at work had been identified as the cause of the symptoms .More specific occupational physical factors associated with medial epicondylitis are forceful activities among men and with repetitive movements of the arm among women.Current smokers and former smokers are also associated with medial epicondylitis, so do patients who suffer from diabetes type 2 .
medial epicondylitis treatment exercises 3

Medial Epicondylitis Treatment Exercises

How Can a Physical Therapist Help? It is important to get proper treatment for medial epicondylitis as soon as it occurs, as tendons do not have a good blood supply. An inflamed tendon that is not treated can begin to tear, causing a more serious condition. When a diagnosis of medial epicondylitis is made, you will work with your physical therapist to devise a treatment plan that is specific to your condition and goals. Your individual treatment program may include: Pain Management. Your physical therapist will help you identify and avoid painful movements to allow the inflamed tendon to heal. Ice, ice massage, or moist heat may be used for pain management. Therapeutic modalities, such as iontophoresis (medication delivered through an electrically charged patch), and ultrasound may be applied. Bracing or splinting may also be prescribed. In severe cases, it may be necessary to rest the elbow and not perform work or sport activities that continue causing pain, which may slow the recovery process. Manual Therapy. Your physical therapist may use manual techniques, such as gentle joint movements, soft-tissue massage, and elbow, forearm, and wrist stretches to help the muscles regain full movement. Your therapist may also do manual stretching and manual techniques to your shoulder and thoracic spine, as your tendons along the medial elbow can be affected by muscle imbalances all the way up the chain. Range-of-Motion Exercises. You will learn mobility exercises and self-stretches to help your elbow and wrist maintain proper movement. Strengthening Exercises. Your physical therapist will determine which strengthening exercises are right for you, depending on your specific condition, as your pain subsides. You may use weights, medicine balls, resistance bands, and other types of resistance training to challenge your weaker muscles. You will receive a home-exercise program to maintain your arm, forearm, elbow, and hand strength long after you have completed your formal physical therapy. Patient Education. Education is an important part of rehabilitation. Your physical therapist may suggest adjustments to how you perform various tasks, and make suggestions to improve your form and reduce any chance of injury. Adjustments made in your golf swing, throwing techniques, or work tasks can help reduce pressure placed on the tendons in the forearm region. Functional Training. As your symptoms improve, your physical therapist will help you return to your previous level of function. Functional training will include modifications in specific movement patterns, promoting less stress on the medial tendons. As mentioned previously in patient education, you and your physical therapist will decide what your goals are, and safely get you back to your prior performance levels as soon as possible. Back to Top

Medial Epicondylitis Treatment Exercises

Medial Epicondylitis Treatment Exercises
Medial Epicondylitis Treatment Exercises
Medial Epicondylitis Treatment Exercises

Be the first to comment

Leave a Reply

Your email address will not be published.


*