Definition of tennis elbow
Classical tennis elbow
• It is the lateral
• Medial tennis elbow tennis elbow (Golfer’s elbow)
• Posterior tennis elbow around the margins of the olecranon process
Location of pain in tennis elbow
• Lateral epicondyle (75%)
• Lateral muscle mass (17%)
• Medial epicondyle (10%)
• Posterior (8%).
Lateral Tennis Elbow
It is a lesion affecting the tendinous origin of common wrist extensors. It is more common in men than women are and is believed to be a degenerative disorder.
Epicondylitis: This is due to single or multiple tears in the common extensor origin, periostitis, angiofibroblastic proliferation of extensor carpi radialis brevis (ECRB), etc.
Inflammation of adventitious bursa: Between the common extensor origin and radio humeral joint.
Calcified deposits: Within the common extensor tendon.
Painful annular ligament: it’s thanks to hypertrophy of synovial fringe between the radial head and therefore the capitulum’s.
Pain of neurological origin, e.g. cervical spine affection, radial nerve entrapment, etc.
Causes in tennis players: quite one-third tennis players everywhere the planet are affected with this problem over 35 years aged .
Pathophysiology and Related Symptoms
Stage I: there’s acute inflammation but no angioblastic invasion. The patient complains of pain during activity.
Stage II: stage II is a stage of chronic inflammation. There is some angioblastic invasion. The patient complains of pain both during activity and at rest.
Stage III: Chronic inflammation with extensive angioblastic invasion. The patient complains pain at rest, night pains, and pain during daily activities.
Patient complains of pain on the outer aspect of the elbow and has difficulty in gripping objects and lifting them. Sportspersons will have difficulty in extending the elbow. The following are some of the useful clinical tests.
Local tenderness on the outside of the elbow at the common extensor origin with aching pain in the back of the forearm.
Cozen’s test: Painful resisted extension of the wrist with elbow in full extension elicits pain at the lateral elbow held in extension, passive wrist flexion and pronation produces pain.
Maudsley’s test: Resisted extension of the center fingerelicits pain at the epicondyle thanks to disease within the extensor digitorum communis.
Radiograph for Tennis Elbow
The Anterior,posterior, lateral and radiocapitellar views are mostly recommended views. In most cases, it is normal. However, in 16 percent of the cases, a faint calcification along the epicondyle are often detected.
It consists of rest and physiotherapy. In tennis players exercises, are light racket, smaller grip, elbow strap, etc. are helpful. Injection of local anesthetic and steroid are useful in 40 percent of cases.
This is the final option before surgery. About 10 percent of the cases do not respond to the conservative treatment. In them, a forceful extension of a fully flexed and pronated forearm after injection may be attempted.
• Severe pain for 6 weeks at least.
• Marked and localized tenderness over lateral epicondyle.
• Failure to respond to restricted activity or immobilization for at least 2 weeks.
• Percutaneous release of epicondylar muscles.
• Bosworth technique of excision of the proximal portion of the annular ligament, release of the origin of the extensor muscles, excision of the bursa and excision of synovial fringes.