Biceps Tendinopathy

Pain, tenderness and inflammation around long head of biceps tendon often caused due to overuse injury among older patients especially older athletes ( 30+ age athletes and old aged patients 60+ age).

Pain often resembles Shoulder impingement syndrome, Rotator cuff tendinopathy.

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EPIDEMIOLOGY

Occurs more commonly while performing or after sporting activities like lifting, throwing, overhead movement.

In UK prevalence rate of biceps tendon rupture is 0.53/100,000 over 5 years, with male:female ratio 3:1.

PATHOPHYSIOLOGY

Repetitive irritation friction leads to swelling of tendon initially.

Continued irritation, traction, friction makes tendon thicker.

Eventually long term irritation leads to adhesion formation around surrounding structures.

CLINICAL FEATURES

Patients with biceps tendinopathy often complain of a deep, throbbing pain in the anterior shoulder that is intensified when lifting.

Patients are likely to present with a chief complaint of anteromedial shoulder pain The pain is usually localized to the bicipital groove and may radiate toward the insertion of the deltoid muscle or along radial distribution

Pain may be aggravated by overhead reaching, pulling and lifting activities. The pain usually worsens at night when sleeping on the affected shoulder.

Pain with palpation over the bicipital groove is another physical exam finding in patients with biceps tendinopathy. Active elbow flexion may also provoke pain. Cases associated with biceps instability, the patient may complain of an anterior shoulder “clicking” or “popping” sensation associated with throwing motions.

PHYSICAL EXAMINATION AND DIAGNOSIS

Physical examination includes Active And Passive ROM testing, Palpation, Clinical Screening and Specific tests

Biceps Tendon tests

SPEED TEST

Resisted shoulder flexion with elbow extended and forearm supinated

Positive if pain felt in bicipital groove

YERGASON TEST

Elbow flexed at 90°. Initially pronated

Active Supination and flexion against resistance

Pain at bicipital groove yields positive result

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DIFFERENTIAL DIAGNOSIS AND MEASURES

SLAP Lesion

Glenohumeral Instability

OsteoArthritis

Sub-Acromial Impingement

Scales used to measure is

DASH (Disability of Arm, Shoulder and Hand)

PHYSIOTHERAPY MANAGEMENT

Physical therapy has been commonly used for the treatment of tendinopathies, especially eccentric training.

Intervention should include restoration of pain free range of motion, trunk and core stability and ensuring stable scapulothoracic rhythm. Pain free range can be achieved with such activities as Passive Range of Motion, Active Assisted Range of Motion, and mobilization. Painful activities such as abduction and overhead activities should be avoided in the early stages of recovery as it can exacerbate symptoms.

Initial Conservative Management includes application of ice to the affected area for 10-15 minutes, 2-3 times per day for the first 48 hours. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are used for 3-4 weeks to treat inflammation and pain

Stretching and strengthening regimes are a common aspects of most therapy protocols. Therapists also use other modalities like ultrasound, iontophoresis, deep transverse friction massage, low-level laser therapy, Hot fermentation.

Rehabilitation Exercise Regime includes

Active Elbow Flexion and Extension

Biceps Stretch

Biceps Curl

Single arm Shoulder flexion

Resisted Shoulder Internal Rotation

Resisted Shoulder External Rotation

Sleeper Stretch

Side lying External Rotation

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Stroke

A stroke aka cerebrovascular accident is a condition in which impeded blood flow to the brain results in cell death.There are two main types of stroke:
(a) ischemic, due to lack of blood flow

(b) hemorrhagic, due to bleeding

There is another type when their is partial disruption of blood flow its called Transient Ischemic Attack.

EPIDEMIOLOGY

Stroke is one of the prominent cause of death and disability in India. The estimated prevalence rate of stroke ranges from 84-262/100,000 in rural population and 334-424/100,000 in urban population. The incidence rate is 119-145/100,000 based on the recent population based study.

CAUSES

(a) Ischaemic strokes – The most common type of stroke, occur when a blood clot blocks the flow of the blood in the arteries to the brain. Blood clots form in the part where the arteries have been narrowed or blocked by fatty cholesterol deposits (hypercholesterolemia) known as ‘plaques’. This narrowing of the arteries is caused by atherosclerosis

(b) Hemorrhagic stroke – Also known as cerebral hemorrhage or intracranial hemorrhage primarily caused due to hypertension

Other risk factors include

*Smoking

*Obesity

*Excessive alcohol consumption
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PATHOPHYSIOLOGY

Due to thrombosis or embolism in case of ischemic stroke results in infarction which triggers tissue damage or tissue injury, cell or tissue injury disrupts metabolism leading to ionic disturbance and free radicals formation, calcium and other metabolites accumulate in injured tissue and release excitatory neurotransmitters, continued cell damage eventually results in brain cell death.

Due to impaired cerebral tissue perfusion in case of hemorrhagic stroke results in large blood accumulation in brain tissues which put further pressure in tissues and the regulatory mechanism tries to maintain BP and ICP but eventually cerebral blood vessels gets ruptured and then these vessels constrict in order to limit blood loss and vasospasm occurs, further constriction often leads to tissue necrosis and results in brain cell death

CLINICAL FEATURES

Signs and symptoms

Numbness or weakness of face, arm, or leg (especially one sided)

Confusion or change in mental status

Trouble speaking or understanding speech

Visual disturbances

Loss of balance

Dizziness

Difficulty walking

Abrupt severe headache.

Motor Loss

Hemiplegia

Flaccid paralysis

loss or decrease in the deep tendon reflexes
initially and after 48 hours reappearance of deep reflexes and spasticity

Communication Loss

Dysarthria

Dysphasia or aphasia

Apraxia

Perceptual Disturbances and Sensory Loss

Visualperceptual dysfunctions homonymous hemianopia (loss of half of visual field)

Disturbances in visualspatial relations (perceiving the relation of two or more objects in spatial areas), frequently seen in patients with right hemispheric damage

Sensory losses ( impairment of touch or more severe with loss of proprioception, difficulty in interpretation of visual, tactile, and auditory stimulus

Impaired Cognitive and Psychological Effects

Frontal lobe damage Learning capacity, memory, or other higher cortical intellectual functions may be impaired.

Difficulties in comprehension, forgetfulness, and lack of motivation.

Depression, other psychological problems emotional lability,frustration, and lack of cooperation.

PHYSICAL EXAMINATION AND DIAGNOSIS

The National Institutes of Health Stroke Scale (NIHSS) is a tool used by healthcare providers to objectively quantify the impairment caused by a Stroke

(1) PRE-HOSPITAL STROKE ASSESSMENT SCALE INCLUDES

Cincinati Stroke Scale
Los Angeles Pre hospital stroke scale
ABCD score

(2) ACUTE ASSESSMENT SCALES

Canadian Neurological Scale
European Stroke Scale
Hunt&Hess Scale
Hemispheric Stroke Scale
Glasgow Coma Scale
Mathew Stroke Scale
NIH Stroke Scale

(3) FUNCTIONAL ASSESSMENT SCALE

Berg Balance Scale
Lawton IADL Scale
Modified Rankin Scale

(4) Outcomes Assessment Scale

Barthel Index
Glasgow Coma Scale
Functional Independence Measurement

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PHYSIOTHERAPY MANAGEMENT

(1) Improving Motor Control

Stroke Physical Therapy these therapeutic interventions use sensory Stimulation (e.g. quick stretch, brushing, reflex stimulation and associated reactions) to facilitate movement in patients following stroke (Duncan,1997). The following are the different approaches: –

i.Bobath

ii.Brunnstrom

iii.Rood

iv. Proprioceptive neuromuscular facilitation (PNF)

Developed by Knott and Voss, they advocated the use of peripheral inputs as stretch and resisted movement to reinforce existing motor response. Total patterns of movement are used in treatment and are followed in a developmental sequence.

b. Learning theory approach

i. Conductive education

In Stroke Physical Therapy, Conductive education is one of the methods in treating neurological conditions including hemiplegic patients. Cotton and Kinsman (1984) demonstrated a neuropsychological approach using the concept of CE for adult hemiplegia. The patient is taught how to guide his movements towards each task-part of the task by using his own speech – rhythmical intention.

ii. Motor relearning theory

It emphasises the practice of functional tasks and importance of relearning real-life activities for patients. Principles of learning and biomechanical analysis of movements and tasks are important. (Carr and Shepherd, 1987)

c. Functional electrical stimulation (FES)

FES is a modality that applied a short burst of electrical current to the hemiplegic muscle or nerve. In Stroke Physical Therapy, FES has been demonstrated to be beneficial to restore motor control, spasticity, and reduction of hemiplegic shoulder pain and subluxation.

d. Biofeedback

Biofeedback is a modality that facilitates the electromyographic activity in selected muscle or awareness of joint position sense via visual or auditory cues.

(2) Hemiplegia Shoulder Management

Shoulder subluxation and pain of the affected arm is not uncommon in at least 30% of all patient after stroke ,whereas subluxation is found in 80% of stroke patients

Suggested interventions are as follows

a) Exercise

Active weight bearing exercise can be used as a means of improving motor control of the affected arm introducing and grading tactile, proprioceptive, and kinesthetic stimulation and preventing edema and pain. In Stroke Physical Therapy, Upper extremity weight bearing can be used to lengthen or inhibit tight or spastic muscles.

b) Functional electrical stimulation

Functional electrical stimulation (FES) is an increasingly popular treatment for the hemiplegic stroke patient. It has been applied in stroke physical therapy for the treatment of shoulder subluxation, spasticity and functionally, for the restoring function in the upper and lower limb. In Stroke Physical Therapy, Electrical stimulation is effective in reducing pain and severity of subluxation, and possibly in facilitating restoration of arm function

c) Positioning & proper handling

d) Neuro-facilitation

e) Passive limb physiotherapy

Maintenance of full pain-free range of movement without traumatizing the joint and the structures can be carried out.

f) Pain relief physiotherapy

Passive mobilisation as described by Maitland, can be useful in gaining relief of pain and range of movement (Davies, 1991).

g) Sling

In Stroke Physical Therapy the use of sling is controversial.

(3) Limb physiotherapy

Stroke Physiotherapy includes passive, assisted active and active ranges of motion exercise for the hemiplegic limbs. This can be an effective management for prevention of limb contractures and spasticity

(4) Chest physiotherapy

In Stroke Physical Therapy, evidence shows that both cough and forced expiratory technique are proven effective. Directed coughing and FET can be used as a technique for bronchial hygiene clearance in stroke patient.

(5) Positioning

 In Stroke Physical Therapy consistent reflex inhibitory patterns of posture in resting is encouraged to overcome physical complications of stroke and to aid recovery, therapeutic positioning is a renowned strategy to discourage the development of abnormal tone, contracture, pain and respiratory complications.

(6) Muscle Tone management

A goal of Stroke Physical Therapy interventions has been to “normalize tone to normalize movement.” Therapy modalities for reducing tone include stretching, prolonged stretching, passive manipulation by therapists, weight bearing, ice, contraction of muscles antagonistic to spastic muscles, splinting, and casting. TENS stimulation showed improvement for chronic spasticity of lower extremities

(7) Sensory facilitation and education

Bobath and roods approaches recommend the use of sensory stimulation to promote sensory recovery of stroke patients.

(8) Balance Training

(9) Gait Training

Bobath assumed abnormal postural reflex activity is the cause of dysfunction and disability, so gait training involved tone normalisation and preparatory training for gait activity. In contrast Carr and Shepherd suggests task-related training with methods to increase strength, coordination and flexible musculoskeletal system to develop skill in walking along with treadmill training combined with use of suspension tube

(10) Functional Mobility Training

To handle the functional obstruction of stroke patients, specific functional tasks are explained to them based on movement analysis , these tasks include bridging, rolling to sit to stand, transfer skills, walking and stairing etc

(11) Upper limb conditioning

Many approaches to the physical rehabilitation of adults post-stroke exist that attempt to maximize motor skill recovery. However the literature does not support the efficacy of any single approach. The followings are the current approaches to motor rehabilitation of the UE.

a) Facilitation techniques

They are the most common methods of intervention for the deficits in UE motor skills including Bobath, proprioceptive neuromuscular facilitation, Brunnstrom’s approach and Rood’s approach.

b) Functional electric stimulation

In Stroke Physical Therapy, Functional electric stimulation can be effective in increasing the electric activity of muscles or increased active range of motion in individuals with stroke.

c) Constraint-induced therapy

(13) Mobility aid

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Vojta Method

It is a technique to treat physical and mental disability with the application of ” reflex locomotion “. It was given by Prof. Vaclav Vojta

In reflex locomotion, there is a coordinated, rhythmic activation of the total skeletal musculature and a CNS response at various circuit levels

PRINCIPLES

(1) 18 points in the body – crawling and reflex rolling

(2) placing the child in a particular position and simultaneous Stimulation of vital points can help improve CNS development

(3) Should be applied 4-5 times daily and withdraw if no improvement is noticeable after a year

(4) Following this protocol child learn normal movement pattern instead of abnormal ones

The Vojta Principle starts out from what is known as reflex locomotion.

Prof Vojta witnessed that these children responded to certain Stimulation in certain body positions with recurrent motor activities in the trunk and the extremities

The effects of this activation were positive, the children with cerebral palsy could first speak more clearly, and after a short time they could stand up and walk more assuredly

The Vojta method can be divided into 2
phases:

Reflex creeping (prone lying flat with the chest down and back up)

Reflex rolling (supine lying flat with the chest up and back down)

USES

By Following above mentioned principle it was observed that children with spastic cerebral palsy not present with spontaneous motor activity could now be completed more comprehensively with repeated Stimulation” Prof Vojta concluded that movement development in the infantile spastic might be subject to functional blockades “

Prof Vojta developed a holistic approach for these kinds of clinical manifestation in new-born babies, children and adults popularly called as  ” Vojta Therapy “

INDICATIONS

Congenital muscular torticollis

Cerebral palsy

Hip dysplasia

Infantile Postural Asymmetry

Spina Bifida

MECHANISM

The reflex locomotion elicited by Vojta therapy is associated with changes in cortical and subcortical brain activation. Tactile stimulations on pre-defined zone of body activates central nervous system. If stimulation is given correctly and repeatedly, motor pattern generated are learned by brain and could be executed voluntarily by an individual.

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Parkinson’s Disease

It is a long term degenerative disease of CNS that mainly affects the motor system. Caused due to substantia nigra, cells that make the chemical dopamine start to die. Dopamine acts like a messenger that tells another area of your brain when you want to move a part of your body.The typical appearance of parkinson’s patient is

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EPIDEMIOLOGY

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CAUSES

Oxidative Stress

Lewy bodies

Increasing age

Genetics mutations in the LRRK2, PARK7, PINK1, PRKN, or SNCA gene

Environmental factors

PATHOPHYSIOLOGY

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CLINICAL FEATURES

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PHYSICAL EXAMINATION AND DIAGNOSIS

Physical examination includes Medical history, Signs, posture, gait, appearance etc discussed below

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Imaging techniques applied includes
MRI, CT scan, PET, SPECT Imaging Testings and Dopamine transporter imaging are used to confirm parkinson’s disease

DIFFERENTIAL DIAGNOSIS

Idiopathic parkinson’s

Essential tremor

Huntington disease

Multi system atrophy

PHYSIOTHERAPY MANAGEMENT

Medical management includes use of drugs that increase dopamine levels like combination of Carbidopa-Levodopa, Dopamine agonists, MAO-B inhibitors, COMT inhibitors.

Physiotherapy management includes Exercises that require balance and preparatory adjustment of the body important along with rhythmic activities such as dancing, skipping and cycling that can maintain the ability to perform reciprocal movements.   Finally, exercises that promote attention and learning are beneficial. 

Types of exercises that do this:

Walking

Dancing

Yoga classes

Tai Chi classes

Stepping over obstacles

Marching to music with big arm swings

Sports (ping pong, golf, tennis, volleyball)

Aerobic/Jazz exercise classes  

The European Guideline provides a section that describes the use of motor learning. It takes the form of cued functional and dual task training, compensatory strategy training uses external cues, self-instruction and attention. Examples include:

Visual cueing

Auditory cueing

Attention

Proprioceptive cueing

Along with the same proper gait training, use of assistive devices like walkers rollators etc, balance and posture training and Movement strategy training are also prescribed

Rollators for Parkinson’s

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Spina Bifida

Spina bifida is a neural tube defect that results in incomplete closure of the vertebrae and membranes around the spinal cord.

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EPIDEMIOLOGY

In US each year 1500 babies are born with this defect. Hispanic women (relating to Spain or to Spanish-speaking countries, especially those of Central and South America) have higher rate of having a child with spina bifida. Prevalence rate is 3.80 per 10000 live births among hispanic, among afro-american is 2.73 per 10000 live births and among non-hispanic white is 3.09 per 10000 live births.

CAUSES

Lack of folic acid supplementation

Medications like Valproate and Carbamazepine etc

Family History

Genetic Disorder’s like Patau syndrome, Edward’s syndrome

Other Risk Factors include Obesity and Diabetes

TYPES

Basically divided into three types

Spina Bifida Occulta

Meningocele

Myelomeningocele

Rare types include Spina Bifida Ventralis, Myeloschisis

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Myeloschisis

The myeloschisis (rachischisis) is the severest form in this the nerve tissue is fully bare and a dermal or meningeal covering is absent. 

Spina Bifida Ventralis

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CLINICAL FEATURES AND PATHOPHYSIOLOGY

Spina bifida occulta.
the spinal nerves usually aren’t involved, typically there are no signs or symptoms some visible indications can be seen on the newborn’s skin above the spinal defect, including an abnormal tuft of hair, or a small dimple or birthmark.

Meningocele.
Membranes around the spinal cord comes out through an opening in the vertebrae, forming a sac filled with fluid, but this sac doesn’t include the spinal cord.

Myelomeningocele.
In this severe form of spina bifida.
Spinal column remains open along several vertebrae in the lower or middle back.Both the membranes and the spinal cord or nerves protrude at birth, forming a sac.Tissues and nerves usually are exposed, though sometimes skin covers the sac.

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PHYSICAL EXAMINATION AND DIAGNOSIS

Spina Bifida is often diagnosed with elevated or high level of maternal alpha feto-protein, fetal ultrasound and physical examination

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PHYSIOTHERAPY MANAGEMENT

AIM

Maximising independence in functional activities such as standing, transferring and walking

Provision of mobility aids and equipment to increase independence

Exercises to maintain or improve muscle strength and length

Anticipating, preventing and minimising secondary effects such as development of contractures

Positioning and postural advice

Teaching wheelchair skills to maximise independence

Provision of appropriate orthotics

Exercises to improve balance and coordination to prevent risk of falls

Another important factor on an individual’s walking ability is the use of assistive devices, whether it is a brace, crutches or a walker. In order to promote walking capacity an assistive device may be necessary. The study suggests that ORLAU Parawalker for children may increase their ability to ambulate which can ultimately provide other benefits that were mentioned earlier

More Physiotherapy interventions are discussed below

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Bobath Technique

Bobath technique is a neuro developmental approach for treatment and assessment of individuals suffering primarily from cerebral palsy and also for other neurological deficits.

It is a holistic approach not a specified method for treatment of neurological conditions especially cerebral palsy

For detail video regarding bobath technique visit

http://youtu.be/02erVakUNZk

PRINCIPLES OF BOBATH TECHNIQUE

(1) Bobath therapeutic techniques make normal posture and movement more easy and likely to occur

(2) Bobath technique focuses on interaction of impairment functions and life participation

(3) Movement is a sensory motor experience or integration

(4) By moving proximal parts of the body it is possible to influence change of posture and movement in distal part

(5) It is impossible to superimpose normal movement pattern on abnormal ones its important to inhibit abnormal movements primarily

AIM OF BOBATH TECHNIQUE

Change atypical tone

Mobilise tight structures

Activate appropriate muscle groups

Strengthen weak muscles

Improve quality of posture and movement with hands-on

Take hands off to increase child’s own activity

Encourage child’s problem-solving skills to improve independence

Work within appropriate context to improve functional skills

TECHNIQUES

VISIT THE FOLLOWING LINK

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CONCLUSION

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Carpal Tunnel Syndrome

Compression of median nerve in the carpal tunnel causing numbness, tingling sensation and weakness in hand.

EPIDEMIOLOGY

Mostly affects women than men typically affects women aged between 40-60 years of age with incidence rate most common entrapment neuropathy prevalence rate is 1 in 25 cases. The reported prevalence of carpal tunnel syndrome is between 1% and 7% in European population studies

CAUSES

Repetitive motion overuse injury like typing, playing piano awkward positioning of hand while using keyboard, mouse. Other medical conditions can lead to carpal tunnel syndrome viz

Diabetes

Thyroid dysfunction(hypothyroidism)

Fracture of wrist

Pregnancy due to edema or fluid retention

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Pain, Numbness, Tingling, Burning Sensation in the hand leading to weakness of hand tingling and numbness sensation is felt on thumb, index and middle finger i.e along the distribution of median nerve These symptoms often occur while holding a steering wheel, phone or newspaper. The sensation may wake you from sleep. Patients often tends to “shake out” hand in order to relieve symptoms. Symptoms also disturbs sleep and aggravates early in the morning while waking up.

Median nerve is compressed due to hypertrophy of flexor synovium
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PHYSICAL EXAMINATION AND DIAGNOSIS

Following Physical examination tests are performed to evaluate carpal tunnel syndrome.

Tinel’s Sign

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Phalen’s test

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Reverse Phalen Test

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Other tests includes Carpal Compression Test, Electromyography and Nerve Conduction Studies Ultrasound exam reveals palmar bowing of flexor retinaculum and ultrasound and MRI reveals enlargement of median nerve at the level of pisiform

DIFFERENTIAL DIAGNOSIS

Neuralgic amyotrophy

Brachial plexus injury

Multiple Sclerosis

Cervical Syringomyelia

Pancoast tumor

MEASURES

DASH (Disability of shoulder and hand questionnaire)

BCTQ (Boston Carpal tunnel questionnaire)

MHQ (Michigan Hand Outcome questionnaire)

PEM (Patient Evaluation Measures)

PHYSIOTHERAPY MANAGEMENT

Surgical management includes decompression surgery which comprises of two types (a) open carpal tunnel release OCTR and (b) endoscopic carpal tunnel release

Medical management includes Corticosteroid injection in the carpal tunnel, NSAIDS, Splinting

Physiotherapy includes ergonomic modifications, carpal bone and nerve mobilisation, ultrasound therapy, electromagnetic therapy and splinting. Carpal tunnel rehabilitation exercises includes
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for more information visit

https://www.physio-pedia.com/Carpal_Tunnel_Syndrome

https://www.physiocheck.co.uk/condition/46/carpal-tunnel-syndrome

Tennis Elbow aka Lateral Epicondylitis

also known as lateral epicondylitis defined as inflammation of tendon of extensor compartment of forearm specifically extensor carpi radiallis brevis (ECRB)

EPIDEMIOLOGY AND CAUSES

often results from overuse injury with sporting activities like ratchet sports tennis, squash and other sports like cricket, baseball etc most popular example among sports athletes is Sachin Tendulkar suffered from this disease in general survey annual incidence is 1-3% of the U.S. population. Men and women are equally affected. Typically, lateral epicondylitis affects individuals greater than age 40 years.

CLINICAL FEATURES AND PATHOPHYSIOLOGY

Pain in the lateral compartment of forearm along with tenderness at a point distal to origin of ECRB pain may radiate to posterior aspect of forearm and aggravates with activities like repetitive extension long standing pain may result in weakness of extensor muscles and a characteristic” coffee cup sign” i.e holding coffee cup may trigger pain is observed

Overuse action of extensor muscles may lead to micro tears of the extensor tendon leading to degenerative changes.

PHYSICAL EXAMINATION AND DIAGNOSIS

Following physical examination tests are performed to evaluate tennis elbow

COZEN TEST

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MILL’S  TEST

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Other test includes

MAUDSLEY TEST

CHAIR TEST

WRINGING TEST

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Other diagnostic tools such as ultrasound may reveal micro tears of the tendon and extent of tendon damage X-ray reveal calcification and MRI is used to rule out arthritis

DIFFERENTIAL DIAGNOSIS

Cervical Radiculopathy

Posterior Introsseous syndrome

Radial tunnel syndrome

Fibromyalgia

Elbow Osteoarthritis

MEASURES

Patient Rated Tennis Elbow Evaluation

Visual analogue Scale

QUICKDash(Disability of Arm Shoulder Hand)

PHYSIOTHERAPY MANAGEMENT

Medical management includes Corticosteroid injection at the extensor origin and NSAIDS which helps to relieve pain Physiotherapy management includes pain relief modalities like ultrasound, TENS etc Cyriax Method, IASTM (INSTRUMENT ASSISTED SOFT TISSUE MANIPULATION), Myofascial release of extensor carpi radiallis brevis, Strengthening exercises, Mulligan mobilisation with movement, Stretching techniques
Use of Kinesiotaping, braces, straps provides support and helps in rehabilitation phase

For further information visit

https://www.physio-pedia.com/Lateral_Epicondylitis

Supraspinatus Tendonitis And Shoulder Examination

Supraspinatus Tendonitis is often associated with Shoulder impingement syndrome impingement and inflammation of Supraspinatus Tendon is called Supraspinatus Tendonitis

EPIDEMIOLOGY AND CAUSES

Mostly affects sports athlete often result from overuse injury with sporting activities like throwing and overhead motion apart from this it also affects age group of 50-60 years with prevalence more in patients with diabetes

Factors affecting listed below

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CLINICAL FEATURES

Subdeltoid pain is the most highlighting feature which aggravates with abduction movement Pain also felt while reaching,overhead activity, sleeping on affected shoulder It become worse during night and often disturbs sleep

Painful and limited range of motion and painful arc 70°-120°

Their is anterior instability along with posterior tightness

PHYSICAL EXAMINATION AND DIAGNOSIS

Following physical examination used to evaluate Supraspinatus Tendonitis

Testings:

Neer test

Hawkins Kennedy Test

Empty Can Test

Drop Arm Test

Impingement test

Complete description on how to perform following tests along with other important physical examination of shoulder injury is given below

https://ptmasterguide.wordpress.com/2018/08/22/shoulder-examination/

X-ray Radiography shows calcified lesion around Supraspinatus tendon later cases shows degenerative and sclerotic changes Ultrasound reveals thickening of subacromial bursa

DIFFERENTIAL DIAGNOSIS

AC Joint Injury

Clavicle injury

Rotator Cuff tear

Swimmer’s Shoulder

Impingement Syndrome

Osteoarthritis

Biceps Tendinitis or Tendinopathy

MEASURES AND SCALE

Simple shoulder test questionnaire

Oxford Shoulder Score

PHYSIOTHERAPY MANAGEMENT

Medical management includes Corticosteroid injection, NSAIDS that alleviates pain and surgical procedures include subacromial decompression, sometimes acromioplasty, bursal resection. Physiotherapy management includes Rest, Ice, pain relieving modalities like ultrasound, cryotherapy, Electrical Modalities Stimulation. Their are three phases of Supraspinatus Tendonitis management which includes (a) Immobilisation (b) Assitive range of motion (c) Progressive resistance exercise

ROM exercise, Strengthening exercise, Stretching techniques, Isometric exercises, Codmans classic pendullar exercise and Kinesiotaping, soft tissue manipulation like MFR, IASTM are also prescribed and found to be very effective in pain relief and regaining range of motion. Along with these Home exercise programs, self exercise regimes are also advised

For more details visit

https://www.physio-pedia.com/Supraspinatus_tendinopathy#Epidemiology.2FEtiology