Case Study: Lateral Epicondylitis (Tennis Elbow)

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Clinical Experience (2010–2012)

Presenting Complaint:

A 45-year-old female clerical staff member reported with pain on the outer aspect of her right elbow. She complained of discomfort during wrist extension, gripping objects, and especially while twisting movements like turning a key or wringing clothes. The pain had gradually developed over the past month and had worsened with her daily office work, which involved repetitive keyboard use and paperwork handling.

History and Background:

The patient was right-hand dominant and had no history of trauma. Her occupation required prolonged sitting and repetitive hand movements, contributing to strain on the extensor tendons. Her symptoms were typical of overuse injury, consistent with lateral epicondylitis (tennis elbow).

Assessment:

During the clinical evaluation:

• Observation: No visible swelling or redness

• Palpation: Point tenderness over the lateral epicondyle of the humerus

• Pain Provocation Tests:

o Resisted wrist extension – Positive (elicited sharp pain at the lateral elbow)

o Cozen’s Test – Positive

o Mill’s Test – Positive (increased discomfort with passive wrist flexion)

• ROM:

o Wrist extension – Painful and limited

o Supination/Pronation – Mild discomfort during twisting

• Grip Strength: Reduced due to pain inhibition

Based on the findings, a diagnosis of tennis elbow – right side was confirmed.

Treatment Plan:

The patient underwent a structured 14-day physiotherapy treatment, during which I personally administered and progressed the following interventions:

1. Therapeutic Ultrasound: Applied over the lateral epicondyle for 6–8 minutes to promote tissue healing and reduce inflammation.

2. Soft Tissue Mobilization: Gentle friction massage over the extensor tendon origin to improve local circulation and break fibrotic adhesions.

3. Stretching Exercises: Passive and active stretching of wrist extensors within the pain-free range.

4. Strengthening Exercises:

  • Initially isometric wrist extension and grip strengthening
  • Later progressed to eccentric exercises using light resistance (e.g., theraband, small dumbbell)

5. Activity Modification Advice: Advised to reduce repetitive hand use temporarily and maintain proper wrist posture while typing or writing.

6. Ergonomic Education: Recommended workplace adjustments, including keyboard and mouse positioning.

Outcome Measures:

• Pain Level: Reduced from 7/10 to 1–2/10 by the end of treatment

• Wrist Extension ROM: Fully restored with minimal discomfort

• Functional Improvement: Patient regained the ability to write, type, and perform twisting motions like opening bottles without pain

Prognosis:

With consistent physiotherapy and compliance to the home exercise plan, the patient showed near-complete recovery within 14 days. She was advised to continue strengthening exercises and ergonomic precautions to prevent recurrence. Her prognosis was excellent due to early intervention and positive response to conservative treatment.

“This case highlighted the importance of targeting both local tendon healing and occupational risk factors in managing lateral epicondylitis. Through hands-on care and structured rehabilitation, I was able to help the patient return to her full functional capacity without relying on medication or invasive procedures.”


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