Article: Tennis elbow

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]

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 centrifugal force applied to it. This force can, over a short period of minutes, develop into the specific problem known as tennis elbow.

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.
• Exquisite 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.

Treatment

Although not founded in clinical research^[2] , the tennis player's treatment of choice is frequent icing for inflammation, and taking ibuprofen anti-inflammatory pain-killers. 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

Initial measures

Rest and ice are the treatment of choice. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation. Stretches and strengthening exercises are essential to prevent re-irritation of the tendon^[4] . Splints may be helpful if the tendon is torn. With physiotherapy, ultrasound can be used to reduce the inflammation. Manual therapy (a form of physiotherapy) is an important part of the treatment; it helps to relieve the muscle spasm and helps to stretch out the tightened tissues.

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]

Surgical intervention

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

Alternative treatments

Acupuncture has been proven to be beneficial.^[8]