Orthopedics Book

http://www.fpnotebook.com/

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

Advertisement

  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
    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. Corticosteroid Iontophoresis does not offer benefit
      1. Nirschl (2003) Am J Sports 31:189
    2. Extracorporeal shock wave therapy is not beneficial
      1. Chung (2004) Am J Sports Med 32:1660
  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

Epicondylitis (C0014488)

ConceptsDisease or Syndrome (T047)
ICD9726.32
EnglishEpicondylitis
Spanishepicondilitis del humero
Parent ConceptsEnthesopathy (C0242490), Non-Neoplastic Soft Tissue Disorder (C1335043), Arthritis (C0003864), Osteitis (C0029400), Elbow enthesopathy NOS (C0158307), Elbow joint inflamed (C0574944), Finding of bone of upper limb (C0575527), Inflammatory disorder of extremity (C1285336), Disorder of upper arm (C1290873), Disorder of elbow (C1290875)
SourcesAOD, COSTAR, MTH, MTHICD9, NCI, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Tennis Elbow (C0039516)

Definition (MSH)A condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists.
ConceptsDisease or Syndrome (T047)
ICD9726.32, 726.32
MSHD013716
BasqueEPIKONDILITIS HUMERALA
DanishTennisalbue lateral epikondylit
DutchEpicondylitis lateralis
EnglishLateral epicondylitis, Lateral epicondylitis of elbow, Lateral Humeral Epicondylitides, Lateral Humeral Epicondylitis, TENNIS ELBOW, Tennis elbow - epicondylitis, Tennis Elbows
FinnishTENNISKYYNARPAA
FrenchCoude du joueau de tennis
GermanEpicondylitis lateralis
Hungariantenniszkonyok
ItalianGomito del tennista
NorwegianTENNISALBUE
PortugueseSindrome do cotovelo do tenista
Spanishcodo de tenista, Codo del tenista, epicondilitis, epicondilitis externa, epicondilitis lateral, epicondilitis lateral del codo
SwedishTENNISARMBAGE
Parent ConceptsPeriarthritis (C0031037), Enthesopathy (C0242490), Elbow enthesopathy NOS (C0158307), Musculoskeletal (C0497254), Diagnosis/Diseases Component (C0497531), Arm Injuries (C0003794), Musculoskeletal Diseases (C0026857), Epicondylitis (C0014488), Ambiguous concept (C1274012)
SourcesAIR, AOD, COSTAR, DXP, ICD9CM, ICPC, ICPCBAQ, ICPCDAN, ICPCDUT, ICPCFIN, ICPCFRE, ICPCGER, ICPCHEB, ICPCHUN, ICPCITA, ICPCNOR, ICPCPOR, ICPCSPA, ICPCSWE, LCH, MEDLINEPLUS, MSH, MTH, MTHICD9, NCI, NDFRT, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)


Elbow enthesopathy NOS (C0158307)

ConceptsPathologic Function (T046)
ICD9726.3, 726.30
EnglishElbow enthesopathy unspecified, Enthesopathy of elbow, Enthesopathy of elbow region, Enthesopathy of the elbow region
Spanishentesopatia de la region del codo, entesopatia del codo
Parent ConceptsElbow enthesopathy NOS (C0158307), Peripheral enthesopathies and allied syndromes (C1442902), Arthropathies NOS (C0022408), Enthesopathy (C0242490), Soft tissue lesion of elbow region (C0410030), Finding of elbow joint (C0575640)
SourcesICD9CM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree