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Lateral Epicondylitis
Medial Epicondylitis
Posterior Olecranon Bursitis
Triceps Tendinitis

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    - common in tennis players, manual labobers, office workers
      or home makers who engage in repetitive manual activities.
    - repititive used of wrist extensors
    - usually occurs in persons over 35 y/o
    - an inflammatory lesion with degeneration occurs at the 
      insertion of the extensor tendons, primarily the ECRB, with 
      eventual fibrous adherence to the capsule
    - also closely involved is the origin of the superficial part
      of the supinator
    - other muscles that are felt to possibly contribute are the
      ECRL, EDC
    - hypervascularity, granulation tissue and fibrosis in the extensor 
      aponeurosis and in the subaponeurotic space of the elbow can 
      develop, as can contracture of the anterolateral elbow capsule
    - with history of chronic activity involving repetitive wrist flexion
      and extension or pronation and supination of the forearm
    - onsets can be gradual or sudden
    1. tenderness over the lateral epicondyle
    2. increase pain with resisted wrist extension, pain is greater with
        straight elbow
    3. pain maximally reproduce by having px make a fist, pronate FA
        and radially deviate the wrist while performing the maneuver
    4. middle finger test: resisting extension of the prox. IP jt. of 
        digit 3.
              - (+) pain elicited over the lateral epicondyle

    1. decrease repetitive activity
    2 avoid painful activities
    3. activity modification
    4. equipment modification
    5. used of physical modality
    6. injection of cortisone or xylocaine
    7. FA bands
    8. proper exercise of the wrist extensor with elbow flex 90 deg.
        and elbow extended 180 deg.
    9. surgery
              - lateral extensor release

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    - also known as pitchers or golfer's elbow
    - pain localized to the medial aspect of the elbow
    - develops as a result of a medial stress over load on the flexor
      musculature and medial collateral lig at the elbow
    - seen frequently in skeletally immature, primarilly in 9-15 y/o boys
      as a physeal injury resulting from throwing stresses

    1. pain can be elicited by stressing the flexor tendons with resisted
        flexion at the wrist or force wrist extension
    2. evaluate ROM: valgus and varus stress

    Tx: same as lateral epicondylitis only with emphasis on the
          strengethening of the flexors muscles of the FA as well as the 
          used of modalities for pain relief

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    - olecranon bursa - one of the most frequently inflamed bursae in
      the body; inflammation of the superficial bursa is most frequently
    - seen very commonly in athletes engage in contact sports and in
    - can present as acute, chronic or infectious

    - result from a direct blow or prolonged pressure on the area
    - there is tenderness and distention of the bursa
    - DDx: cellulities, tendinitis, acute arthritis, and ligamentous injury
    - Tx: prevention of recurrence by using elbow pads; aspiration; 
       compression and cold packs for 1st 72 hours; heating modalities

    - occurs from repeated trauma and result in thickening and fibrosis
      of the bursal lining
    - commonly seen in occupational laborers
    - Tx: aspiration followed by compressive dressing; surgical removal
      of the bursa for severe refractory or chronic bursitis

    - diagnosed with aspiration and culture; suspected in the setting of 
      warmth and erythema
    - Tx: antibiotics

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     - seen frequently in persons who engage in activities requiring rapid
       elbow extension, such as throwers and fly fisherman, and in those
       with repetitive motion occupations, such as carpentry

     - Tx: similar to lateral and medial epicondylitis with the mainstay of
        treatment involving reduction of inflammation and activity 

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