1. The Elbow, Forearm, Wrist & Hand Injuries
Epicondylitis (Medial & Lateral) & Carpal Tunnel Syndrome Annie Sullivan & Chris Vanaman

2. Lateral .vs. Medial Epicondylitis
Lateral – “tennis elbow”
Stemming from a backhand stroke involving overextending the wrist.
Medial – “golfer/throwers elbow”
May result from a number of different sport activities that require repeated forceful flexions of the wrist.

3. Anatomic Location Lateral – Lateral Epicondyle
Extensor Carpi Radialis Brevis (ECRB)
Outside of Elbow
Medial –
Medial Epicondyle
Extensor Carpi Radialis Brevis (ECRB)
Inside of Elbow

4. Causes of Epicondylitis
Poor General Conditioning/Technique
Overuse
Jobs with Vigorous/Repetitive Use of the Forearm Muscle
Painters
Plumbers
Carpenters
Auto Workers
Cooks
Butchers

5. Signs/Symptoms of Epicondylitis
Pain/burning on the outer part of the elbow
Weak grip strength
Inflammation & Swelling
Pain increased with resisted wrist extension
Pain usually begins as mild & slowly worsens over weeks & months.
Increased pain noted with gripping handshake

6. Facts/Statistics about Epicondylitis
Lateral Epicondylitis is one of the most common problems of the elbow occurring in sports.
The annual incidence is 1-3% of the U.S. population.
Tennis Elbow surgery is considered successful in 80-90% of patients.
For the average person who develops a single- occurrence of tennis elbow, most symptoms will usually disappear between 9.6 and 12 months.

7. Care/Treatment/Prevention
Rest or Watchful Waiting
Non-Steroidal Anti-Inflammatory Drugs (NSAIDS)/Medicines
Physical Therapy (Rehabilitation)
Counterforce Bracing/Brace

8. What is Carpal Tunnel Syndrome?
Compression of the median nerve; located in the carpal tunnel.
Carpal tunnel is formed in the wrist by the carpal bones and the transverse carpal ligament.

9. Causes Heredity Some people have smaller carpal tunnels Overuse
Prolonged use of the hand can lead to CTS
Ex. typing

10. Statistics The female to male ratio is 3:1
The peak age range for development of CTS is years old
Only 10% of patients are younger than 31
The incidence of CTS is 1-3 cases per subjects per year

11. Anatomy of the wrist
Median nerve- feeling in palm side of the thumb, index finger, and long fingers
Flexor tendons- bend the fingers
*Both are affected by CTS

12. Stages of CTS
Early- occasional pain only at night; fluids are redistributed to upper limbs while resting; tendency to flex wrists while resting which increases pressure
Intermediary- more frequent symptoms and they occur during the day and night
Advanced- symptoms are constantly present

13. Symptoms Numbness Tingling Pain in the hand
Electric shock-like feeling
Strange sensations traveling up the arm

14. Treatments Nonsurgical Bracing/splinting Medications Activity changes
Steroids
Surgical

15. Bracing/splinting Braces can be worn at night
Reduces aggravation that may occur while the wrist is curled up during sleep
Also can be worn during activities that may cause irritation of medial nerve

16. More Treatments
Medications NSAIDS Activity Changes Change positions to reduce irritation; take breaks

17. Steroids
May help alleviate pain but the pain may come back

18. Surgical Interventions
Surgery is an option for those with severe symptoms
Surgery will release the transverse ligament
High initial success rates (>90%)
Low complications
Long term success rate is not very high (~60% after 5 years)

19. Epicondylitis Picture Sources
golfer%E2%80%99s-elbow/
Chiropractic-Helps-Patient-Carl-Gentry-Keep-the-Music-Alive

20. Carpal Tunnel Syndrome Picture Sources
brace
carpal-tunnel/