Lateral Epicondylitis (DTF)

The project began with the formulation of a PICO question in an area of interest to guide the literature search. The PICO (population, intervention, control, and outcomes) format was used as a strategy for framing a foreground evidenced-based question. Dissecting the question into its component parts and restructuring was an essential first step in the evidence-based practice project. After careful consideration of the clinical manifestations and practitioner professional experience, the PIO question emerged was, Does Kinesio taping decrease pain and improve engagement in functional tasks in patients with shoulder pathology? Fortunately, there was sufficient evidence within the literature to support the PIO question.

Course Description : Lateral Epicondylitis is a condition that accounts for between 1-3 % of all musculoskeletal complaints in an MDs office. To date limited research exists to explain the efficacy of a clear approach in its assessment and management. This course will expose the participant to current concepts in the literature surrounding the etiology of the condition, the limited evidence surrounding the special tests for lateral epicondylitis and the role of proximal structures in these tests. Further discussion will focus on the importance of ruling out proximal conditions and the roles that each plays in elbow pain. The instructors will then shift focus to current

CA MTUS supports facet injections for non-radicular facet mediated pain. In addition, ODG criteria for facet injections include documentation of low-back pain that is non-radicular, failure of conservative treatment (including home exercise, PT, and NSAIDs) prior to the procedure for at least 4-6 weeks, no more than 2 joint levels to be injected in one session, and evidence of a formal plan of additional evidence-based activity and exercise in addition to facet joint therapy. This is an appeal to a previously denied request on 02/09/16. The latest note and the appeal letter stated that the reviewing doctor denied the joint injections because there was no documentation of ruling out radiculopathy. The bottom line is that this patient has MRI scan evidence of both disc pathology and facet arthropathy. It was noted that the patient has been symptomatic since 2005. He has continued back pain with a recent 10/12/15 date of

In the article there was a case study that they were studying a twenty-seven year old patient came in with some mild to server pain. The patient was an amateur golfer who had developed symptoms like developing some small pain in her left arm shortly after the pain developed she changed jobs were she was required to type for long periods of time. She then began to notice that the pain became more sever when she was at the driving range. Shortly following this incident she noticed that she had trouble lifting heavy items. A week prior to her visit she was experiencing shooting pains down her arm. The doctor did a physical exam on the patient and did not notice any color change or swelling. The diagnosis with left lateral epicondylosis. With the

Sedentary tendinopathy pts did not respond as well to eccentric loading for tendon rehab as did athletes in prior studies.

Lateral epicondylitis, better known as “Tennis elbow” is a form of tendonitis. It causes the tendons within the bony structure to swell; it can also cause pain in the elbow which radiates to the arm. The article from WebMD states “These tendons are tough tissues that connect the muscles of your lower arm to the bone”1. Commonly referred to tennis elbow, someone can get this form of tendonitis without playing tennis a day in their lives. It is usually a result of overworking or repetitive motion of those tendons.

A post hoc-pair-wise comparison test was done to obtain the mean change among the three treatment groups with p values. P values that was greater than 0.5 were considered to be significant for the study. The author found that there were some changes in the participants physical activities where the TENS unit had caused the Fibromyalgia pain to subside where patients were able to have an improved quality of life. The effectiveness of this study does remain controversial due to TENS unit being self-administered by the

Ankylosing spondylitis usually starts in the sacroiliac joints, which connect the spine and the pelvis together. In fact, the telltale sign that joint inflammation is caused by AS, and not another type of arthritis, is chronic lower back pain that is worse in the morning, feels better after exercising, and seems to come and go in flares for no apparent reason. The pain can fluctuate from side to side in the sacroiliac joint.

12/08/15 Progress Report described that the patient presented with pain in lower back and buttocks without radiation to the lower extremities. The patient reported significant pain relief due to intra-articular facet block done on 04/14/14 for his left side. TPIs have been improving his pain. The patient noted exacerbation of low back pain after moving appliances yesterday. Pain level was 7/10 with the use of medications. He would be starting PT next week. The patient underwent right-sided transforaminal ESIs at L4 and L5 levels without any significant long-term pain relief. It was helpful for a short duration. Facet joint injections caused increase in lower back and buttock pain. SI joint injection has improved his pain to 3/10. The lower back pain is aching, sharp, shooting, sore, and throbbing with pins and needles. The pain is constant and the pain aggravates with ambulation and standing. The patient also has bilateral leg pain due to varicose veins. The patient is currently on Elavil, Planquenil, Lunesta, Flexeril, Ompeprazole, compounding cream, Tramadol, Vitamin B12, Gabapentin, Voltaren gel and Duloxetine. Exam revealed an antalgic gait. There was significant tenderness to

the cartilage within a joint. Cartilage is the tissue between the joints to ensure that they

The strength of this recommendation is inconclusive. As practitioners, we should have minimum restraint in following this recommendation and should be on the lookout for new evidence in addition to strongly listening to patient preference. This recommendation is based upon three RCT’s. Two of these studies were of high strength and one was of moderate strength with regard to quality. All three of these studies had moderate applicability. In these studies, pain improvement was not consistently statistical significant (MD = .81, 95% CI -1.76, .14; MD = 2.26, p<.001; MD = -.82, 95% CI -1.247, -.39), and neither was function (MD = 3, 95% CI -1.05, 7.05; MD = 6.54, p=.001). In addition, the authors concluded the clinical significance of these findings were

Kinesio taping involves affixing tape to the skin folds to increase the space between the muscle and the fascia and to increase circulation. McConnell tape is applied in an effort to restrict abnormal patella tracking, believed to reduce joint friction. Researchers in this study hypothesize that the pain relief may actually be in accordance with the gate control theory of pain modulation. They say more study is needed, but it appears that both tapes stimulate cutaneous mechanoreceptors which may be the mechanism for pain reduction. This is noteworthy for physical therapy, because this could also reinforce the use of other physical therapy interventions, in treating patients with patellofemoral dysfunction. Specifically, the use of massage or patellar joint mobilizations since these modalities may work under the same principle of pressure overriding pain receptors. If reducing pain is a goal for a patient, then Physical Therapists and Physical Therapist Assistants can add Kinesio taping and McConnell taping to the list of successful interventions to treat patients with PFPS as revealed in this

The patient should stay active but avoid heavy lifting or physical work. Doctors will prescribe regular pain relievers to manage the disorder. Referral would be crucial to help in physical treatments, multidisciplinary and manipulation approaches, which should take place after every two weeks. The suitable multidisciplinary approaches include cognitive behavioral therapy, McKenzie exercises as well as chiropractic manipulative therapy and standard GP to decrease the pain and boost physical

Have you ever had a continuous chest pain, that hurts when you ate or did any physical activity? Well, perhaps you have costochondritis! Because not a lot of people have heard of costochondritis, they should learn its symptoms, causes, treatments, and how to learn to live a lifestyle with it.

The last group of rats received no TENS at all. “Thermal and mechanical pain thresholds were assessed in right hind paw before and 12 days after the CCI surgery.”(Somers & Clemente) 2 The results concluded several things about TENS managing neuropathic pain. “Applying the high rate frequency daily reduced the development of mechanical allodynia in CCI rats and low rate frequency reduced the development of thermal allodynia, but only when the TENS was delivered on the left side.”(Somers & Clemente) 2 “Indications showed that TENS delivered contralateral to a nerve injury best reduces allodynia development.”(Somers & Clemente) 2 “Comprehensive reduction of allodynia development would need to be a combination of high and low frequency TENS intervention.”(Somers & Clemente) 2