Tennis Elbow

Aka: Tennis Elbow, Lateral Epicondylitis, Epicondylitis, Elbow Enthesopathy, Radiohumeral Bursitis

1. See Also
   1. Golfer's Elbow (Medial Epicondylitis)
2. Pathophysiology
   1. Much more common compared with Medial Epicondylitis
   2. Inflammation of extensor Forearm muscle origins
   3. Associated with backhand swing in tennis
3. Etiology
   1. Repeated overuse of Forearm flexors or extensors
   2. Minor tears of tendinous attachments at epicondyles
   3. Causative activities
      1. Golf or racquet sports
      2. Throwing sports
      3. Hammering
      4. Hand sanding
      5. Computer mouse use
4. Symptoms
   1. Dull ache at lateral epicondyle
   2. Gradual onset of pain
   3. Worsened with affected muscle use
      1. Forearm Rotation or grasping
      2. Opening a jar
   4. Pain radiates into Forearm
5. Signs
   1. Maximum tenderness localized over lateral epicondyle
   2. Provocative maneuvers eliciting pain
      1. Wrist extension and supination against resistance
      2. Pain on resisted wrist extension
      3. Pain on resisted long finger extension
6. Differential Diagnosis
   1. Radial Nerve entrapment Neuropathy
      1. Posterior interosseous nerve compression
   2. Radiocapitellar chondromalacia
   3. Osteochondritis dissecans capitellum
7. Radiology: Elbow XRay
   1. Usually negative
   2. Occasional traction spur may be seen
8. Management: Initial pain management
   1. Rest
   2. Ice for 20 minutes qid and after Exercise
   3. Moist heat or Ultrasound
   4. NSAIDs
   5. Tennis Elbow counterforce strap
      1. Dampens force transmitted to elbow from wrist, hand
      2. Struijis (2004) Am J Sports Med 32:462-9
   6. Activity restriction
      1. Avoid grasping in pronation
      2. Lift only with wrist in supination
   7. Ergonomic workplace and sports modifications
9. Management: Rehabilitation Exercises
   1. Painless passive wrist flexion
   2. Progressive resisted wrist extension
      1. Use elastic band tied between foot and hand
10. Management: Refractory Cases
    1. Epicondyle Injection (Corticosteroid local injection)
    2. Long Arm Cast of elbow and wrist
       1. Avoid immobilization if possible
       2. Indicated for failed conservative therapy above
       3. Wrist immobilized so affected muscles relaxed
       4. Lateral Epicondylitis cast
          1. Elbow flexed at 90 degrees
          2. Forearm supinated
          3. Slight wrist dorsiflexion into 10-20 degrees
11. Management: Ineffective measures
    1. CorticosteroidIontophoresis does not offer benefit
       1. Nirschl (2003) Am J Sports 31:189-95
    2. Extracorporeal shock wave therapy is not beneficial
       1. Chung (2004) Am J Sports Med 32:1660-7
12. Prognosis
    1. Self limited, expect full recovery
    2. Symptoms may persist for months
    3. Surgery for resistant cases only
13. References
    1. Hay (1999) BMJ 319:964-8