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Re: Dx Bilateral Lat Epicondylitis
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Re: Dx Bilateral Lat Epicondylitis - March 26, 2006 1:25:00 PM
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PTupdate.com
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I just hope that newer PT's are not reading this thread and taking things too seriously. How quickly one will lose respect from an orthopod when the patient goes back saying "Joe PT told me that there is no such thing as lateral epicondylitis, and every body with elbow pain has something wrong with the spine between their shoulder blades"....and then a corticosteroid injection promptly relieves the symptoms forever, and the PT looks like an idiot.
John Duffy, PT OCS
[URL=http://www.PTUpdate.com]www.PTUpdate.com[/URL]
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John M. Duffy, PT
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Re: Dx Bilateral Lat Epicondylitis - March 26, 2006 2:20:00 PM
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ginger
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You seem like such a nice boy John, what a pity your bias prevents you from taking a step forward.
Seems you've been hooked by the dark side.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: Dx Bilateral Lat Epicondylitis - March 26, 2006 4:00:00 PM
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PTupdate.com
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"You seem like such a nice boy John"...what are you, a grandmother? I have been on the dark side for a while...I kind of like it here.
Duffy
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www.PTupdate.com
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Re: Dx Bilateral Lat Epicondylitis - March 27, 2006 5:08:00 AM
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ehanso
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I agree that we need keep an open mind about how we diagnose and treat complicated situations. A routine lateral epicondylitis (epiconylosis) may respond well to injection, US, deep tissue work, exercise or other localized treatment. Then there are those that are more complex and chronic and need to be treated differently. As part of the inital visit, it can be worthwhile to do a cervical and thoracic screen. Each of us uses our knowledge and experience to provide what we feel is the most appropriate care for each patient. That does not mean that we are more right or more wrong. There are numerous ways to skin a cat. In the end the cat is still skinned. Besides in any one approach was fool proof the others would not exist.
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Re: Dx Bilateral Lat Epicondylitis - March 27, 2006 8:10:00 AM
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Shill
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There are a lot of bold statements being made here. We all "know" that sometimes conditions that seem like extremity conditions actually arent. BUT......
I have yet to see anything (in this post) other than anecdotal reports of treating elsewhere solving a lateral epicondylitis problem. Id like to see someone cite a published report, of a patient who presented with textbook epicondylitis symptoms. Duff is right, anyone claiming excellent results needs to be able to back up what they are doing, so lets see the money be put where the mouth is. OR, is it just that the research hasnt caught up with our excellent ability to treat this way?
Steve
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Re: Dx Bilateral Lat Epicondylitis - March 27, 2006 9:12:00 AM
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nari
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John
Have a think about WHY that injection works.
Analgesic effect...antinociceptive...reducing sP...etc etc. Where is the pain originating?
Not the periphery...
Steve
I don't think research has caught up with what we do because we do all sorts of things to the poor elbow and it would be extremely impossible to squeeze the variables into a RCT.
Nari
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 4:07:00 AM
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PTupdate.com
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I am not saying that the neck has no influence on the elbow...in fact, I am treating two persons with "lateral epicondylitis" diagnosis where the symptoms really are coming from the neck. However, I am also comfortable saying that there are still elbow problems, and there is no way people are going to convince me that the elbow is rarely the culprit, especially in this case, where an elbow injection gave 6 months of relief early on in the process.
As far as an injection providing relief at a referred site, I have yet to see anything in the literature supporting this. I personally have tried anesthetic injection into cervical referred pain, with no change in symptoms, as expected.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
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www.PTupdate.com
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 4:14:00 AM
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FLAOrthoPT
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but what if the radial nerve was entrapped or irritated and the injection helped that? is it still a pure epicondylitis? Would you still treat it the same?
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 4:40:00 AM
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PTupdate.com
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Sure, radial nerve entrapment at the Arcade of Frosche or in the supinator could be relieved by a corticosteroid injection. If pure entrapment, I would expect symptoms to return with use. If just pure inflammation, they may not. But, unless dealing with double crush type syndrome, again hard to jump immediately to the neck/thoracic spine.
As Shill indicates, we need to see some evidence to the contrary. I'd love to see a study where the majority of persons with "confirmed" tennis elbow were successfully treated without ever touching the elbow...only the C/T spine and neural system.
John Duffy, PT OCS
[URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
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John M. Duffy, PT
Board Certified Orthopaedic Clinical Specialist
www.PTupdate.com
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 6:33:00 AM
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JLS_PT_OCS
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http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15609491&query_hl=1&itool=pubmed_docsum
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9252000&query_hl=1&itool=pubmed_docsum
We don't have to choose elbow vs central, folks. When I see the dx of lateral epicondylitis, I usually do:
Tx manipulation
Cx mob/manip lower Cx spine
UE neurodynamic eval a la Shacklock
Neural mobs a la shacklock
DNF strength
Shoulder muscle length assessment and stretching
Wrist extensor stretching
Wrist extensor eccentrics, starting at 90 flexion and working out toward extension
Self TFM
Radial mobilization per Duff's suggestions
I try to limit the HEP to about 4 exercises of what I think are most important. However overall there's no reason we can't treat locally and centrally at the same time. Let's have the best of both worlds if possible, right?
Buddy- I am ready to believe your laser device works. It is incumbent upon the manufacturers and/or supporters to prove that with a well-controlled study.
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 7:10:00 AM
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Shill
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Good point about using both Jason.
But how does one do wrist extensor eccentrics starting at 90 degrees flexion? You must mean 90 degrees of elbow flexion, not wrist flexion, right?
Steve
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 1:08:00 PM
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SJBird55
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I have to extend a thanks to Duffy. I have a guy attending PT secondary to supposed lateral epicondylitis. Well... there are no overuse issues. He's disabled secondary to hepatitis and has frequent life threatening situations because of the hepatitis. Well, he's got right elbow pain. Ever since the research has come out regarding thoracic and cervical mobilization, I have incorporated them into my treatment sessions. For this particular guy, he had a 3/5 strength for extensor carpi radialis brevis the first day. After one treatment of thoracic and cervical mobilization, he had a 5/5 and painfree resistance. He no longer dropped things, could hang onto his coffee cup and could squirt his deodorant. So, I was thinking great... he'll be done quickly. Well, he's okay, but he still had just a light nagging discomfort in the lateral elbow. It was quite tender to palpation and it was kind of over the lateral epicondyle and kind of over the radial head region - more in a bony location. So... I've never done that radial technique that Duffy described... but today I tried it. Exactly like he said it would be AND painfree afterwards. I'll learn the results of it in a few days, but I'm pretty sure it was a radial head issue too.
I guess maybe I'm clinically agreeing with Jas.
I can't say that I've ever got on this darn forum and pulled up a post to see how to do a treatment in front of a patient until today. It is nice having the flexibility of a tablet. LOL So, thank you Duffy. I told him I probably should have sent him to PA and he would have had quicker results. LOL I told him I'm a little slow, what takes you 2 treatments takes me 4. LOL
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 3:47:00 PM
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PTupdate.com
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You are quite welcome SJ.
Duffy
The Grand Percolator
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John M. Duffy, PT
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 6:15:00 PM
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Bournephysio
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I prefer a ****** press myself.
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Re: Dx Bilateral Lat Epicondylitis - March 28, 2006 6:15:00 PM
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Bournephysio
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How about a francais press?
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Re: Dx Bilateral Lat Epicondylitis - March 29, 2006 1:25:00 AM
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SJBird55
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From: Michigan
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All right... what is that? I can only think of a francais fry... a francais kiss...
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Re: Dx Bilateral Lat Epicondylitis - March 29, 2006 6:51:00 AM
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Bournephysio
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A francais press is a particularly good way of making coffee. You throw some course coffee grinds in with hot water. Let them steep for a few minutes then use a special plunger to push the grounds to the bottom. One of the main brands of francais press is bodum so a lot of people just call it a bodum. A percolator is another way of making coffee.
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Re: Dx Bilateral Lat Epicondylitis - March 29, 2006 10:30:00 AM
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SJBird55
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From: Michigan
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OH... LOL I'm quite ignorant in the ways of coffee.
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Re: Dx Bilateral Lat Epicondylitis - March 29, 2006 11:37:00 AM
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srcase
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From: Michigan
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I was thinking of the overhead triceps exercise with dumbbells....no clue!
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Re: Dx Bilateral Lat Epicondylitis - March 29, 2006 1:14:00 PM
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silverfish
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From: Charlotte, NC
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Spank,
I hear Dskells has been asking about you! Go Gannon
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