Lateral Epicondylitis

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Frequently referred to as "tennis elbow," "rug beater's elbow," or "jailer's elbow," lateral epicondylitis is a common condition found in athletes, workers, and musicians. Arising from the humeral lateral epicondyle, the extensor-supinator muscles may be strained or contused through repetitive shear activities that cause microscopic tearing and inflammation at the origin of the common extensor tendon. Gripping an instrument, a piece of sporting equipment, or a tool further aggravates the injury. The exact etiology of lateral epi-condylitis continues to be debated with mechanical, metabolic, and occupational theories cited. Riek et al. attribute lateral epicondylitis to the eccentric contraction at near maximum length of the extensor carpi radialis brevis,43 and Lieber et al point to the ECRB's biphasic sarcomere length as the elbow moves from full extension to full flexion, resulting in eccentric muscle contraction.17 Poor conditioning and/or poor technique may result in stress and inflammation of the extensor supinator muscle group, as with a racquet player who repetitively leads with the elbow on a back

Fig. 17-23 Wrist extension immobilization splint, type 0 (1) The wrist splint is positioned in extension to reduce strain at the common extensor origin.

hand shot.34 Symptoms of lateral epicondylitis include pain localized to the lateral epicondyle or lateral aspect of the elbow. A common history includes exertion involving grip and deviation of the wrist. Baseball pitchers may not be able to grip a ball and throw with elbow extension, while carpenters overuse their arms with hammering, and politicians describe symptoms secondary to shaking countless hands. Instrument players, especially violin and keyboard players, who use excessive twisting motions and/or poor coordination patterns have increased propensity for developing lateral epicondylitis.18,19

As with other overuse injuries, early treatment goals include reducing stress to the involved muscle groups, identification and adaptation of damaging use patterns, and patient education. Two separate randomized controlled trials (RCT) document wrist immobilization as a statistically significant, effective method for treating lateral epicondylitis. One RCT study found no significant difference between patient groups receiving wrist immobilization splinting and corticosteroid injections,13 and another RTC study found no statistically significant difference between immobilization casting of the wrist and taking a recognized nonsteroidal anti-inflammatory.16 Both studies recommended splinting/casting over injection or pharmacological intervention because splinting/casting lacks adverse side effects associated with drug-administered therapy.

For acute problems, a type 0, wrist extension immobilization splint immobilizes the wrist in dorsi-flexion, decreasing tension on the ECRB and other muscles in the extensor-supinator group (Fig. 17-23). In severe cases an elbow flexion, forearm neutral, wrist extension immobilization splint, type 0 (3) may be used to immobilize the wrist in dorsiflexion, forearm in neutral, and elbow in 90° flexion. Designed to reduce irritation and control abusive force over

Fig. 17-24 Nonarticular proximal forearm splint

This nonarticular forearm splint design may reduce pain during activities that induce lateral epicondylitis. A variety of nonarticu-lar forearm splint design options are available. (Courtesy Aircast, Summit, N.J.)

Fig. 17-25 Wrist neutral immobilization splint, type 0 (1)

Conservative management of medial epicondylitis may include 6-8 weeks of splinting the wrist at neutral or slight flexion to decrease activity level.

Fig. 17-24 Nonarticular proximal forearm splint

This nonarticular forearm splint design may reduce pain during activities that induce lateral epicondylitis. A variety of nonarticu-lar forearm splint design options are available. (Courtesy Aircast, Summit, N.J.)

Fig. 17-25 Wrist neutral immobilization splint, type 0 (1)

Conservative management of medial epicondylitis may include 6-8 weeks of splinting the wrist at neutral or slight flexion to decrease activity level.

loads, nonarticular forearm splints, such as the Aircast* pneumatic armband, are also options (Fig. 17-24).28,29 Nonarticular forearm splints are not positioned directly over the lateral epicondyle but over the tender area of the forearm, which is easily identified with resistive wrist extension. Splinting is augmented with exercise and patient education programs. Accompanying exercise regimes and modality use differ considerably from clinic to clinic. While many devices and techniques are touted for treating lateral epicondylitis, none provides relief to all individuals. Patients must be treated on a case-by-case basis to find the best possible solution for each person.

As pain diminishes, the rehabilitative program increasingly focuses on identifying, analyzing, and changing detrimental use patterns. It is important to identify the aggravating activity so that further injury is avoided upon return to work, sport, or playing a musical instrument. Reconditioning and balanced muscle strengthening combined with adaptation of the job situation, playing techniques, and/or equipment used are key elements to preventing recurrence of symptoms. Activities that repeatedly combine wrist extension and supination with resistance must be identified as well as grasp patterns used with tools and sports equipment. For musicians, decreasing the relative weight of instruments through use of a tripod stand or a harness often helps. Splints should not obstruct instruments' sound capacity or the motions required in playing.14 For tennis players, this means defining and altering improper stroke mechanics, assessing the racquet and experimenting with different sized racquet grips, heads, and string tensions. Mea

*Aircast Corporation, Box T, Summit, NJ 07901; www.aircast.com.

surement of the ring finger along the radial border from the proximal palmar crease to the tip of the ring is a good technique for determining handle size.4a28,29

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Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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