Tennis elbow

Tennis elbow

• 1.
  Tennis Elbow(Lateral epicondylitis)
• 2.
  What is tenniselbow? •Tennis elbow/lateral epicondylitis is the tendinopathy of the common extensor-supinator tendon. • Lateral periepicondylar pain and tenderness that is exacerbated by forceful repetitive wrist extension.
• 3.
  Epidemiology • Average ageof presentation is 30-50yr • Male and female are equally affected • 75% of pt have symptoms in their dominant arm
• 4.
  Pathology • Degenerative microtearsin common extensor-supinator tendon due to repetitive mechanical overload. • The tendinous origin of Extensor carpi radialis brevis most commonly affected. • Microscopic feature of surgical specimen:  Hyaline degeneration  Fibroblastic and vascular proliferation- angiofibroblastic hyperplasia  Microscopic calcification
• 5.
  Clinicalfeatures • Usually anActive individual of 30 or 40 years. • Pain and tenderness over lateral epicondyle of elbow. • Acute or insidious onset of pain. • History of over use, involving forceful gripping, repetitive flexion- extension at wrist or pronation-supination activity. • Pain aggravated by movements like pouring out tea, turning stiff door handle, shaking hands, lifting weights,etc. • Elbow looks normal and flexion and extension are full and normal.
• 6.
  Physical Examination • Localisedtenderness at or just below the lateral epicondyle • Cozen’s test: painful resisted extension of the wrist with elbow in full extension elicits pain at the lateral aspect of elbow • Mill’s test: Elbow held in extension ,passive wrist flexion and pronation produces pain.
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  Imaging • X-ray elboware usually normal • USG -focal hypoechoic areas seen • MRI -shows tendon thickening with increased T1 and T2 singal intensity
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  Differential diagnosis • Radialtunnel syndrome: posterior interosseous nerve entrapment between the fibres of supinator muscle. Clinically pain will increase with resisted supination. Pain is located 3- 4cm distal to lateral epicondyle. • Osteochondritis dissecans of the elbow: patient may complaint of snapping or locking. Maximum tenderness found posterior to lateral epicondyle. • posterolateral elbow plica:painfull clickling at terminal exetension and forearm supination as well as maximal tenderness over posterior radiocapitellar joint
• 9.
  Conservative Treatment • 90%of ‘tennis elbow’ will resolve spontaneously within 6-12 months. • First step is to identify and restriction or modification of the activities which cause pain. • In acute stages use of ice pack, use of NSAIDS(preferably topical) can be useful. • Compression strap applied distal to bulk of extensor mass(to reduce maximum contraction) is helpful. It is used only during aggravating activity. • Injection of tender area with corticosteroids and local anaesthetic relieves pain but is not curative. • Physical therapy: ultrasound therapy, remedial exercises may be effective in long term
• 10.
  Operative treatment • Indicatedin sufficiently persistent or recurrent cases usually after 6- 12 months of failed conservative management. Options : I. Open debridement of the diseased tissue of the ECRB II. Percutaneous release
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