tailieunhanh - Care of Musculoskeletal Problems in the Outpatient Setting - part 4
Yêu cầu bệnh nhân để cố gắng để nâng một chiếc ghế với khuỷu tay mở rộng, tay pronated, và vai adducted. Đau đáng kể và không có khả năng nâng ghế là chẩn đoán của epicondylitis bên. Epicondylitis bên, hay khuỷu tay quần vợt, là vấn đề khuỷu tay phổ biến nhất | 6. Elbow Problems 103 significant problem that will require more extensive measures to treat. A test that will confirm the diagnosis has been called the chair test. Ask the patient to try to lift a chair with the elbow extended hand pronated and the shoulder adducted. Significant pain and inability to lift the chair is diagnostic of lateral epicondylitis. Lateral epicondylitis or tennis elbow is the most common elbow problem seen in primary care. The term tennis elbow is a misleading term as only Figure . Resisted wrist extension for lateral epicondylitis. 104 . Shahady about 5 of patients with lateral epicondylitis are tennis players. The problem is seen in association with any sport or occupation that involves repetitive wrist extension. Lateral epicondylitis is caused by degeneration or tendinosis of the attachment of the musculotendinous tendons of the wrist extensor muscles to the lateral epicondyle of the distal humerus. The specific pathophysiology remains to be defined clearly. The primary muscle involved is the origin of the extensor carpi radialis brevis muscle. The only other diagnosis that should be entertained is osteoarthritis of the radiocapitellar joint or the radial head. This is not that common and the history is different. The key to the diagnosis of radial head pathology is pain over the radial head limitation of elbow pronation and supination Figure and pain with that movement. The radial head is palpated just below the lateral epicondyle as noted in Figure . As the extensor muscle attachments are in close proximity it is easy to find discomfort in the vicinity of the radial head in lateral epicondylitis. But the motions of pronation and supination will not be limited or produce pain in lateral epicondylitis as they will in radial head pathology. The vast majority of the time no additional studies are needed to make the diagnosis of lateral epicondylitis. If you suspect radiocapitellar osteoarthritis because of difficulty with .
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