Tennis elbow

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Tennis elbow
Classification & external resources
ICD-10 M77.1
ICD-9 726.32

Tennis elbow (or lateral epicondylitis -- lat. epicondylitis lateralis humeri) is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Whilst it is called "tennis elbow", it should be noted that it is by no means restricted to tennis players. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to the complaint. The condition was first described in 1883.[1]

Contents

[edit] Aetiology

With tennis elbow, the common extensor tendon origin at the Lateral epicondyle of the humerus is irritated, inflamed, damaged and potentially torn.

Men and women are equally affected and there are two typical patterns of occurrence: as an acute onset typically seen in young athletes, and as a chronic condition seen in older people.[1]

Those tennis players with harder, more forceful serves feel gradually worsening pain after ten to twenty serves have been hit. The stress on the elbow can be great due to the centripetal force applied to it. This force can, over a short period of minutes, develop into the specific problem known as tennis elbow.

[edit] Symptoms

  • Outer part of elbow (lateral epicondyle) tender to touch.
  • Lateral elbow pain radiating to extensor aspect of the forearm.
  • Movements of the elbow or wrist hurt, especially lifting movements.
  • Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee.
  • Pain usually subsides overnight.
  • If no treatment given, can become chronic and more difficult to eradicate.

[edit] Treatment

Although not founded in clinical research[2] , the tennis player's treatment of choice is frequent icing and compression (Cold compression therapy) for inflammation, and taking anti-inflammatory pain-killers, such as ibuprofen. In general the evidence base for intervention measures is poor.[3] A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain. Also, ergonomic considerations are important to help with the successful relief of lateral elbow pain.

[edit] Initial measures

Rest, ice and compression are the treatments of choice. There are many excellent cold compression therapy products available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation.

[edit] Exercises and stretches

Stretches and strengthening exercises are essential to prevent re-irritation of the tendon[4]. Progressive strengthening for this condition involves using weights or elastic theraband to increase wrist flexion strength (grip strength). Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff and scapula muscles to reduce any overcompensation in the wrist flexors in gross arm movements (such as a swing).

[edit] Physiotherapy

With physiotherapy, ultrasound can be used to reduce the inflammation and promote collagen production although the current evidence for its efficacy is inconclusive. Manual therapy (a form of physiotherapy) is an important part of the treatment; and can take the form of elbow joint mobilisations/manipulations and/or extensor muscle tissue mobilisations. Nerve mobilisation can also be helpful if the Physiotherapist finds a positive nerve tension test in their assessment. The most common upper limb nerve found to be sensitive is the radial nerve for this condition. Elbow clasps are also found to give temporary relief of symptoms.

[edit] Local steroid injections

Intra-articular glucocorticoid steroid injections can resolve episodes for several months, but there is a risk of later recurrence. Following an injection, the patient normally experiences increased pain over the subsequent day before the steroid starts to settle the condition over the next few days[5] . As with any steroid injection, there is a small risk of local infection and tendon rupture. Most doctors will restrict after two injections giving further courses, as there is less likelihood of effectiveness but increased risk of side-effects.

As opposed to short-term effects[6] , the longterm benefits of local steroid injection are less clearly established.[7]

[edit] Surgical intervention

If conservative measures fail, release of the common extensor origin may be helpful.

Indications for operation:
Tennis elbow (lateral epicondylitis) which has not responded to conservative treatment .

Anaesthetic:
General Anaesthetic (Fully asleep) or regional (the arm will be numb) Local anaesthetic will be injected into the wound for post-operative pain relief

Operation type:
Open

Incisions:
A 3cm incision over the lateral epicondyle (the tender area).

Procedure:
The common extensor origin is released from the lateral epicondyle and scar tissue removed.

Wound Closure:
A single non-absorbable suture running under the skin will be used to close the wound, paper stitches will be placed over this.

Dressings:
An Elastoplast dressing will be placed over the top of the paper stitches and an elastic support bandage over the top of this.

Immediate aftercare:
You can go home when you feel comfortable.

[edit] Alternative treatments

Laser Therapy

The Use of Laser Therapy (Low Power or Low Intensity Laser Therapy) is a currently used treatment. The approach was spun off of research on how light affects cells. The findings, that light stimulates and accelerates normal healing, sparked the creation of several devices. The dosage often determines the extent of the success with this treatment, so it is generally recommended that experienced clinicians apply the therapy with a device that can be 'customized.' Professional athletes have used the therapy, and it has gained attention in the media lately, on shows like the Canadian health program "Balance" on CTV.

Acupuncture has been proven to be beneficial.[8]

[edit] See also

[edit] References

  1. ^ a b Kaminsky SB, Baker CL Jr (2003). "Lateral epicondylitis of the elbow". Tech Hand Up Extrem Surg 7 (4): 179-89. PMID 16518219. 
  2. ^ Manias P, Stasinopoulos D (2006). "A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy". Br J Sports Med 40 (1): 81-5. PMID 16371498 abstract. 
  3. ^ Bisset L, Paungmali A, Vicenzino B, Beller E (2005). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia". Br J Sports Med 39 (7): 411-22; discussion 411-22. PMID 15976161 abstract. 
  4. ^ Stasinopoulos D, Stasinopoulou K, Johnson MI (2005). "An exercise programme for the management of lateral elbow tendinopathy". Br J Sports Med 39 (12): 944-7. PMID 16306504 abstract. 
  5. ^ Lewis M, Hay EM, Paterson SM, Croft P (2005). "Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial". Clin J Pain 21 (4): 330-4. PMID 15951651. 
  6. ^ Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W (2002). "Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults". Cochrane Database Syst Rev (2): CD003686. PMID 12076503. 
  7. ^ Altay T, Gunal I, Ozturk H (2002). "Local injection treatment for lateral epicondylitis". Clin Orthop Relat Res (398): 127-30. PMID 11964641. 
  8. ^ Jiang ZY, Li CD, Guo JH, Li JC, Gao L (2005). "[Controlled observation on electroacupuncture combined with cake-separated moxibustion for treatment of tennis elbow]". Zhongguo Zhen Jiu 25 (11): 763-4. PMID 16335198. 

[edit] External links

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