EPICONDYLITIS-PT

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					                                                              PHYSICAL  THERAPY  PRESCRIPTION

SETH  C.  GAMRADT,  MD
ORTHOPAEDIC  SURGERY  AND  SPORTS  MEDICINE
UCLA  DEPARTMENT  OF  ORTHOPAEDIC  SURGERY
1250 16th Street, Suite 3145
Santa Monica, CA 90404
310.319.1234 Appointments                                                                       PATIENT STICKER


CA  License:  A769260
www.gamradtortho.com


DIAGNOSIS:    ( LEFT / RIGHT / MED / LAT) EPICONDYLITIS                                        DATE__________________

                           ELBOW  EPICONDYLITIS  PHYSICAL  THERAPY  PRESCRIPTION  

___    Range  of  mo<on  (Ac<ve,  Ac<ve  Assisted,  Passive),  
         Flex/  Ex/  Pro/  Supina<on  
  
___  Passive  stretching  Wrist  Extensors
         Begin  with  Elbow  flexed
         Progress  to  stretching  with  Elbow  in  extension

___  Begin  with  Isometric  exercises,  then  progress  to  eccentric  exercise
        Begin  with  Elbow  flexed
        Progress  to  Elbow  extension

___  Wrist  extensor  strengthening  -­‐  start  wrist  curls  with  1  lb.  >>  progress  to  12  lbs.

___  Wrist  flexor  strengthening

___  Grip  strengthening  (tennis  ball  squeeze)

___  Goal  is  sprint  repe<<ons  to  fa<gue  without  pain

___  Ice  before  and  aZer  rehab  exercises

___  Modali<es  (s<m.  Ionto,  US)
Treatment:  ________  Dmes  per  week                DuraDon:  ________  weeks                ___  Home  Program
**  Please  send  progress  notes.

Physician’s  Signature:_____________________________________________
Seth  C.  Gamradt,  MD,  ALending  Orthopaedic  Surgeon,  UCLA  

				
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