Medial epicondylitis

Tennis elbow is an overload or overuse condition in which the muscles of the forearm are affected – in particular the muscles that flex the wrist – the ‘forehand’ muscles in tennis or the muscles of the dominant arm in golf.

Although the condition is termed ‘golf elbow’ since it is common in golfplayers, only a small proportion of patients actually get the condition from playing golf.

The forehand muscles are attached to the medial epicondyle of the humerus. Hence the other term for it is medial epicondylitis – since the ‘common flexor attachment’ is involved due to the repetitive strain.

Statistics on Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

Golfer’s elbow is less common than tennis elbow. It is common in sportsmen and middle aged people, though it occurs in younger and older persons as well.

Risk Factors for Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

• Golf – with golf there is repetitive use of the muscles causing flexion of the wrist.
• Tennis – similarly, in tennis, repetitive use of the ‘forehand’ muscles causing flexion of the wrists can lead to this condition, especially with putting more top-spin on the ball.
• Other sports and occupational activities may be a cause – involving a lot of flexion of the wrist – gripping, grasping etc
• A direct blow to the elbow may also cause it.
  

  Progression of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

  
  
• The pain may develop gradually or occasionally it may be sudden.
• At the moment the small tear occurs the patient may feel nothing, though several days later an ache develops.
• The pain is worse with activities such as turning on taps, turning door handles, shaking hands.
• The pain often subsides with time if the person abstains from the activity.
  

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Diagnosed?

  No investigations are needed for the diagnosis of golfer’s elbow – the diagnosis is clinical.

  Prognosis of Medial epicondylitis (medial tennis elbow, Golfer’s elbow)

  This is not a serious condition, though it can be reasonably disabling in the sense that it limits certain activities, and the person’s work. It usually lasts for months – as long as 24 months, though this depends on treatment and whether the exacerbating activity is stopped.

  How is Medial epicondylitis (medial tennis elbow, Golfer’s elbow) Treated?

  The mainstay of therapy is:
  
  
• Abstaining from exacerbating activities;
• Anti-inflammatory medications (e.g. Non-steroidal anti-inflammatories, Cox-2 inhibitors – though prolonged use may lead to gastritis);
• Gradual stretching and strengthening exercises – such as:
  - Wringing exercises – e.g. rolling up a hand towel, then ‘wringing’ the towel, by first flexing the wrist for 10 seconds, and then extending the wrist for 10 seconds.
  - Weights: sitting with the arms rested, a weight is grasped with the palm facing upwards, and raised by flexing the wrist then extending – gradually increasing the weight.
• Injection of a corticosteroid and local anesthetic (1ml each) may be tried into the lateral epicondyle – up to 2 injections 2-4 weeks apart may be tried.
• After resolution of the condition – the person can gradually return back to the offending activity, though with caution. A non-stretch band or a brace placed 3cm below the elbow may help.

Lateral Epicondylitis

Tennis elbow or lateral epicondylitis is a common injury causing pain on the outside of the elbow.

Despite it's name, this condition is not commonly seen in tennis players but more in work related elbow injuries particularly where repetitive stress is involved. Tennis elbow symptoms can be similar to those of other elbow injuries so it is important to get a correct diagnosis early on.

Symptoms of tennis elbow typically consist of pain about 1 to 2 cm down from the bony part on the outside of the elbow called the lateral epicondyle. The patient will have weakness in the wrist and difficulty doing simple tasks such as opening a door handle or shaking hands with someone. Pain is reproduced when pressing just below the lateral epicondyle on the outside of the elbow as well as when trying to straighten or extend the hand and fingers against resistance. See tennis elbow diagnosis for more information on how tennis elbow is diagnosed.

Entrapment of the radial nerve is another injury with symptoms similar to tennis elbow. Tennis elbow symptoms can also be caused by neck injury

Tennis elbow or Lateral epicondylitis as it is sometimes technically known is inflammation of the lateral epicondyle or bony bit on the outside of the elbow where the muscles attach. However, actual inflammation of the tendon is rare and the cause of the lateral elbow pain could be degeneration of the tendon.

It occurs most commonly in the tendon of the Extensor carpi radialis brevis muscle where there is an increase in pain receptors in the area making the region extremely tender.

The most common cause of tennis elbow is overuse or repetitive strain caused by repeated extension or bending back of the wrist against resistance. Gripping heavy objects like a manual screw driver, weight training or handling bricks will also cause tennis elbow. This is seen much more often than in tennis players.

However, if tennis is thought to be the cause then the following should be considered. A poor backhand technique in tennis. If the wrist is bent when striking a back hand the huge forces are transferred through the tendons to the elbow rather than through the entire arm. A racket grip that is too small. This will make the muscles work harder increasing the forces through the tendon. Strings that are too tight. More shock and energy will be transmitted through the forearm from the ball. Playing with wet, heavy balls.

Two types of onset are commonly seen. Sudden onset of tennis elbow occurs in a single instance of exertion such as a late back hand where the extensors of the wrist become strained. This is thought to correspond to micro-tearing of the tendon. Late Onset: This normally takes place within 24-72 hours after an intensive term of unaccustomed wrist extension. Examples may be a tennis player using a new racket or even a person who's spent a weekend doing DIY..

Upper limb muscles

The muscles of the superior limb arise from three different developmental primordia – the caudal branchial arches, the hypaxial body wall, and the limb bud. The first two groups, the branchial arches and body wall muscles, form attachments with the pectoral girdle and help stabilize and move the proximal end of the limb. The muscles of the limb proper (brachial, antebrachial, and hand muscles) and some of the shoulder joint muscles, which migrate secondarily back onto the trunk wall, are all derived from the embryonic limb bud. This is a highly varied group of muscles with a wide range of functions. The muscles range from large muscles that play major roles in supporting and stabilizing the limb, yet produce very small ranges of movement, to other muscles that produce the greatest range of movements in the entire body. Because of its diverse embryonic origins, the muscles of this group receive their nerve supply from different sources. Some of the muscles are supplied by cranial nerves (branchial arch muscles), another is innervated by body wall ventral rami (levator scapulae), and the remainder are supplied by the ventral rami that form the large brachial plexus that courses through the entire upper limb.

Risk Factors for Alzheimer's Disease

While the specific cause or the cure for Alzheimer's disease is not known, the disease appears to develop when the combined effects of certain risk factors reach a threshold level. Many of these risk factors are known but there are likely others that are yet to be identified. When the threshold level is reached, the brain's ability to repair and maintain itself is overwhelmed, and the disease process begins. 

Risk factors increase the chances of getting Alzheimer's disease. Age and genetics are two risk factors that can not be changed. However, it may be possible to reduce many of the other known risks for the disease through lifestyle choices. 

Age 
Advancing age is the most significant risk factor for Alzheimer's disease. Most people who develop Alzheimer's disease are over the age of 65. However the disease process is thought to begin years before cognitive and memory impairments are apparent. It is important to remember that most people do not get Alzheimer's disease as they age. It is not a normal part of aging. Whatever other risk factors are present, Alzheimer's disease never sets in until some minimum adult age is reached. 

Genes 
The familial form of the disease (FAD), passed on directly from generation to generation, accounts for only about 7% of the total incidence of Alzheimer’s disease. While the common form of the disease (sporadic Alzheimer's disease) also has some genetic links much is still unknown. The majority of cases have no single identifiable cause. The role of genetics continues to be studied. 

Other Risk Factors Include:

• Unhealthy eating habits
• Diabetes
• High blood pressure
• High cholesterol levels
• Strokes
• Obesity
• Stress
• Chronic inflammatory conditions
• History of clinical depression
• MCI (mild cognitive impairment)
• Low levels of physical activity
• Low socio-economic status
• Inadequate exercising of the brain
• Low levels of formal education
• Brain injury
• Smoking

Diagnosing Alzheimer’s disease

Since there is no single definitive medical test for identifying Alzheimer’s disease, arriving at the correct diagnosis can take time and patience. Diagnosing Alzheimer's requires a detailed evaluation, including:

A thorough history of symptoms from the patient and spouse or family, including past and present functioning. Determining classic patterns can help your doctor eliminate other causes of Alzheimer’s symptoms, and also distinguish Alzheimer’s from other forms of dementia.

A physical and neurological exam, including cognitive tests to assess such things as orientation (ability to recall details about self, place, and time), attention span, speed of information processing, working memory, and mood and personality.

Other tests, such as brain imaging and blood tests, to rule out other medical causes.

To diagnose Alzheimer's disease from your symptoms, a doctor will look for:

Significant memory problems in immediate recall, short-term, or long-term memory.

Significant thinking deficits in at least one of four areas: expressing or comprehending language; identifying familiar objects through the senses; poor coordination, gait, or muscle function; and the executive functions of planning, ordering, and making judgments.

Decline severe enough to interfere with relationships and/or work performance.

Symptoms that appear gradually and become steadily worse over time.

Other causes to be ruled out to ensure memory and cognitive symptoms are not the result of another medical condition or disease, such as mild cognitive impairment.

Alzheimer's Disease

Alzheimer's disease is a progressive, degenerative disease of the brain, which causes thinking and memory to become seriously impaired. It is the most common form of dementia. 

The disease was first identified by Dr. Alois Alzheimer in 1906. He described the two hallmarks of the disease: 

• Plaque: Numerous tiny dense deposits scattered throughout the brain which become toxic to brain cells at excessive levels.
• Tangles: Twisted fibers that interfere with vital processes eventually "choking" off the living cells.

When brain cells degenerate and die, the brain markedly shrinks in some regions. 

The Effects of Alzheimer's Disease

Alzheimer's disease eventually affects all aspects of a person's life: how he or she thinks, feels and acts. Since individuals are affected differently, it is difficult to predict the symptoms each person will have, the order in which they will appear, or the speed of the disease's progression. 

In general the following will gradually be affected by the disease: 

Mental Abilities
A person's ability to understand, think, remember and communicate will be affected. The ability to make decisions will be reduced. Simple tasks that have been performed for years will become more difficult or be forgotten. Confusion and memory loss, initially for recent events and eventually for long-term events, will occur. The ability to find the right words and follow a conversation will be affected. 

Emotions and Moods 
A person may appear uninterested and apathetic, and may quickly lose interest in the hobbies they previously enjoyed. The ability to control mood and emotion may be lost. Some individuals are less expressive and are more withdrawn. However, it is now becoming clear that a person even in the later stages of the disease may continue to feel joy, anger, fear, love, and sadness. 

Behaviour 
Changes will develop in the way the person reacts to his or her environment. These actions may seem out of character for the person. Some common reactions include repeating the same action or words, hiding possessions, physical outbursts and restlessness. 

Physical abilities 
The disease can affect a person’s physical co-ordination and mobility, leading to a gradual physical decline. This will affect the person's ability to independently perform day-to-day tasks such as eating, bathing and getting dressed. 

Tuberculosis

Tuberculosis (TB) is an infectious disease that usually infects the lungs, but can attack almost any part of the body. Tuberculosis is spread from person to person through the air. When a person with TB in their lungs or throat coughs, laughs, sneezes, sings, or even talks, the germs that cause TB may spread through the air. If another person breathes in these germs, there is a chance that they will become infected with tuberculosis. 

It is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time.

If it is not treated, TB can be fatal. But TB can almost always be treated and cured if you take medicine as directed by your healthcare provider. Once you begin treatment, within weeks you will no longer be contagious. That means you can't spread the disease to others. If you take your medicine just as your healthcare provider tells you, all the TB germs should be killed.

What are the Symptoms of TB?

A person with TB infection will have no symptoms. A person with active TB disease may have any, all or none of the following symptoms:

• A persistent cough
• Constant fatigue
• Weight loss
• Loss of appetite
• Fever
• Coughing up blood
• Night sweats

These symptoms can also occur with other diseases so it is important to see a healthcare provider and to let them find out if you have TB. A person with TB disease may feel perfectly healthy or may only have a cough from time to time. If you think you have been exposed to TB, get a TB test.

How is TB Detected?

TB can be detected through a skin test or a TB blood test.

The skin test is done by injecting a small amount of fluid called tuberculin into the skin in the arm. You will be told to return within 48 to 72 hours to have a healthcare worker check the arm to see if a bump has developed. The healthcare worker will measure the bump and tell you if your reaction to the test is positive or negative. If it's positive, it usually means you have been infected with the TB germ.

The TB blood test measures how your immune system reacts to the germs that cause TB.

If you have a positive test for TB infection, it only means that you have been infected with TB germs. It does not tell whether you have developed TB disease. You will be given other tests, such as a chest x-ray and a check of your sputum (coughed up mucus), to see whether you have TB disease.