Lateral Elbow Tendinopathy

Tennis Elbow Secrets Revealed

Tennis Elbow Secrets Revealed

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Lateral elbow tendinopathy or lateral epicondylitis, commonly called "tennis elbow," is caused by repetitive overuse of the wrist extensor and forearm supinator muscles that originate at the lateral epicondyle of the humerus—more specifically, the extensor carpi radialis brevis tendon. Once thought to result from inflammation, lateral elbow tendinosis is probably caused more by chronic changes in the musculotendinous matrix (Nirschl, 1992), with minimal inflammation present, particularly with symptoms present for more than 4 to 6 weeks. Microtears, chronic granulation tissue, and scar tissue formation are often seen in pathologic specimens of surgical cases of tennis elbow.

Patients present because of pain in the lateral aspect of the elbow and may complain of weakness or restricted elbow motion, but this is not as common. Pain is worsened by gripping, turning handles, and lifting activities, particularly with the hand in a palm-down position, as in lifting a suitcase, briefcase, or purse. Common positive physical examination findings include tenderness to palpation of the lateral epi-condyle of the elbow and over the proximal wrist extensor and forearm supinator muscle tendons. Pain is intensified with resisted wrist extension and forearm supination. Pain can also limit patient strength. There should be no tenderness directly over the radial head, with normal ligamentous stability and neurovascular status.

Plain radiographs are not needed to make an accurate diagnosis of lateral epicondylitis but should be considered in patients with a history of trauma, motion loss, or locking or with a prolonged period of pain.

Management focuses on pain control and restoration of normal elbow function. Cryotherapy, ice massage, and nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen are excellent pain relievers. NSAIDs and corticosteroid injection have been mainstays of treatment, although they are now questioned because inflammation no longer seems a main factor in the injury process. Corticosteroid injections help quickly reduce the pain of lateral elbow tendinosis, but do not alter long-term outcome (Smidt et al., 2002). Cortisone injection may lead to a short-lived increase in pain in a large percentage of patients (Wang et al., 2003).

Counterforce straps can effectively reduce discomfort in some patients (Fig. 30-15). The strap is applied just distal to the area of maximal tenderness. The strap may relieve some of the tension exerted on the affected muscle tendon units during activities, thereby reducing pain. However, straps, medications, and injections should not replace therapeutic exercises, which include massage, stretching, and strengthening exercises. The most effective stretch is performed with the elbow extended, forearm fully pronated, and wrist flexed. From this position, gentle traction is applied to the middle and ring fingers toward the olecranon. Strengthening exercises with light weights for wrist extension and forearm supination can be done.

Most patients with lateral elbow tendinopathy will obtain excellent relief of symptoms with the program just described, although minimal evidence exists to support these plans (Bissett et al., 2005). If these measures do not lead to adequate relief, other protocols can be added. Formal physical therapy is often used in recalcitrant cases. Treatments such as w

Figure 30-16 Medial epicondylitis may be diagnosed clinically by pain localized to the medial epicondyle during wrist flexion and pronation against resistance. There is often pain elicited after making a tight fist, and grip strength is usually diminished on the affected side.

(From Morrey BF [ed]: The Elbow and its Disorders. Philadelphia, Saunders, 1985.)

Lateral Elbow Tendinopathy

Figure 30-15 Lateral elbow counterforce brace. Note that wide, nonelastic support is curved to fit the conical forearm shape. This does not allow for full muscular expansion, thereby diminishing intrinsic muscular force on the lateral epicondyle.

(From Morrey BF [ed]: The Elbow and Its Disorders. Philadelphia, Saunders, 1985.)

Figure 30-15 Lateral elbow counterforce brace. Note that wide, nonelastic support is curved to fit the conical forearm shape. This does not allow for full muscular expansion, thereby diminishing intrinsic muscular force on the lateral epicondyle.

(From Morrey BF [ed]: The Elbow and Its Disorders. Philadelphia, Saunders, 1985.)

prolotherapy, dry needling, platelet-rich plasma injections, and extracorporeal shock wave therapy are still experimental, and studies have not fully proved their effectiveness. Surgical intervention is sometimes needed and has excellent results.

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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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