Tennis elbow
Classification & external resources

Left elbow-joint, showing posterior and radial collateral ligaments. (Lateral epicondyle visible at center.)
ICD-10	M77.1
ICD-9	726.32
DiseasesDB	12950
eMedicine	orthoped/510  pmr/64 sports/59
MeSH	D013716

Tennis elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called "tennis elbow", it should be noted that it is not restricted to tennis players. If one hyperextends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The condition was first described in 1883.^[1]. The medical term is lateral epicondylitis. Image File history File links No higher resolution available. ... Grays illustration of a human femur, a typically recognized bone. ... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... Elbow redirects here. ... For other uses, see Tennis (disambiguation). ... Year 1883 (MDCCCLXXXIII) was a common year starting on Monday (link will display the full calendar) of the Gregorian calendar (or a common year starting on Saturday of the 12-day slower Julian calendar). ...

Etiology

With tennis elbow, the extensor carpi radialis brevis tendon has been identified as the primary site of pathological change. There have also been pathological changes found at the extensor digitorum communis, longus and ulnaris tendons. The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm. There is no evidence relating mode of onset to pathology although it is generally acknowledged that tennis elbow is caused by repetitive microtrauma/overuse. Inflammatory changes have been noted in the acute stages of the condition but have been found to be absent if symptoms become chronic (3 months +). This may explain why approaches such as corticosteroid injections have little impact in the chronic stages of the condition. Although the name suggests otherwise, tennis elbow can affect anyone - not just racquet sport players. However, there are numerous studies that have implicated racquet sports as a cause or contributing factor for tennis elbow. The peak incidence is between 34 to 54 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated. A weak association has been found between work and tennis elbow development. Risk factors for this condition vary from taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group). The extensor carpi radialis brevis is specific human muscle. ... The Extensor digitorum communis arises from the lateral epicondyle of the humerus, by the common tendon; from the intermuscular septa between it and the adjacent muscles, and from the antibrachial fascia. ...

Symptoms

• Pain on the outer part of elbow (lateral epicondyle).
• Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
• Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee or throwing a baseball.
• Pain usually subsides overnight.
• If no treatment given, can become chronic and more difficult to eradicate.

Differential diagnosis for tennis elbow includes anconeus compartment syndrome, bursitis, cervical radiculopathy, radio-humeral joint dysfunction, hypothyroidism, lateral epicondyle avulsion, musculocutaneus nerve entrapment, non-union of radial neck fracture, osteoarthritis, posterior interosseous syndrome, posterolateral rotatory instability, radial nerve tension, radial tunnel syndrome, rheumatoid arthritis, strained lateral collateral ligaments, and snapping plicae syndrome. The lateral epicondyle of the humerus is a small, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow-joint, and to a tendon common to the origin of the Supinator and some of the Extensor muscles. ... Bursitis is the inflammation of one or more bursae, or small sacs of synovial fluid, in the body. ... This article or section does not cite its references or sources. ... Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease, or in more colloquial terms wear and tear), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints and destruction or... Radial Tunnel Syndrome is a condition where the radial nerve becomes swollen and frictions within the tunnel of muscles through which it passes in the forearm and also behind the elbow, called double entrapment. Radial Tunnel Syndrome is often misdiagnosed as Tennis Elbow, or Epicondylitis and is a type of... Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. ...

Treatment

Applying heat and ice in combination works extremely well, as ice controls swelling and heat heals and promotes blood flow and also relieves the tightness and pain. http://www.fitlinxx.com/Article.htm?id=365

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. There are very few or no other articles that link to this one. ... Ibuprofen (INN) (IPA: ) (from the earlier nomenclature iso-butyl-propanoic-phenolic acid) is a non-steroidal anti-inflammatory drug (NSAID) originally marketed as Nurofen and since under various trademarks, including Act-3, Advil, Brufen, Dorival, Herron Blue, Panafen, Motrin, Nuprin and Burana (Finland), Ipren or Ibumetin (Denmark and Sweden), Ibuprom...

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. There are very few or no other articles that link to this one. ... Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs, are drugs with analgesic, antipyretic and anti-inflammatory effects - they reduce pain, fever and inflammation. ...

Exercises and stretches

Stretches and progressive 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 pain free grip strength and forearm strength. Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff, scapulothoracic and abdominal muscles by Physiotherapists to help reduce any overcompensation in the wrist extensors during gross shoulder and arm movements. Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons. Strapping of the forearm can help realign the muscle fibers and redistribute the load.

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. Physical therapy can help restore lost functionality in many people. ... For other uses, see Ultrasound (disambiguation). ... Manual Therapy encompasses the diagnosis and treatment of the ailments of various etiologies through hands-on intervention. ... Physical therapy can help restore lost functionality in many people. ...

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 giving further courses after two injections, as there is less likelihood of effectiveness but increased risk of side-effects. Glucocorticoids are a class of steroid hormones characterised by an ability to bind with the cortisol receptor and trigger similar effects. ... This article is about the chemical family of steroids. ...

As opposed to short-term effect^[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. It may be undertaken under general anaesthesia or regional block. In modern medical practice, general anaesthesia (AmE: anesthesia) is a state of total unconsciousness resulting from general anaesthetic drugs. ... Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ...

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. However, studies evaluating the efficacy of laser therapy for tennis elbow are currently contradictory. Photobiomodulation also called Low Level Laser Therapy (LLLT), Cold Laser Therapy, Laser Biostimulation, phototherapy or just Laser Therapy. ...

Acupuncture has also been proven to be beneficial but evaluation studies are also inconclusive.^[8] Acupuncture chart from Hua Shou (fl. ...

References

See also

• Golfer's elbow
• Repetitive strain injury
• Radial tunnel syndrome

Golfers elbow, or medial epicondylitis, is an inflammatory condition of the elbow which in some ways is similar to tennis elbow. ... A repetitive strain injury (RSI), also called cumulative trauma disorder, occupational overuse syndrome, or work related upper limb disorder (WRULD), is any of a loose group of conditions resulting from overuse of a tool, eg. ... Radial Tunnel Syndrome is a condition where the radial nerve becomes swollen and frictions within the tunnel of muscles through which it passes in the forearm and also behind the elbow, called double entrapment. Radial Tunnel Syndrome is often misdiagnosed as Tennis Elbow, or Epicondylitis and is a type of...

External links

• Wilson JJ, Best TM (2005). "Common overuse tendon problems: A review and recommendations for treatment". Am Fam Physician 72 (5): 811-8. PMID 16156339} Full article PDF. 
• Medinfo article on Tennis elbow
• Tennis Elbow treatment with stretching exercises Works also for Golfer's Elbow
• Tennis elbow on orthopedics.about.com
• BBC Sport Academy: What is tennis elbow?
• "Tennis elbow:Even cricketers and housewives can get it" - Times of India article dated September 4, 2004 explaining tennis elbow following Sachin Tendulkar contracting it