Tennis Elbow: "Lateral Epicondylitis"

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Definition:

"Pain over the lateral aspect of the elbow that is aggravated by movement of the wrist, by direct palpation over the lateral epicondyle and by contraction of the extensor muscles of the wrist" (Struijs et al, 2003)

"The cardinal physical signs of lateral epicondylitis are pain to direct palpation over the lateral epicondyle and reproduction of pain and weakness during grip strength testing" (Vicenzino,2003)

Epidemiology:

1-3% general population affected (vicenzino, 2003)

Equal prevalence in both genders but longer and more severe in females ( Vicenzino & Wright 1995) 

5% risk in populations performing repetitive manual tasks (Chiang et al,1993)

Causes:

  • Repetitive movement of the wrist occupation related injuries 
  • Degenerative changes causing Fibroblasts proliferation, Vascular hyperplasia, Disorganised collagen 
  • Problems with the whole upper limb kinetic chain (posture) (abnormal movement)
  • Some can have Cervical spine involvement
  • Some can have Upper limb neural involvement
  • Some can have Supinator muscle compression of radial tunnel (radial nerve)

Symptoms and Effects:

Pain on gripping
Grip strength weakness
Lack of inflammatory markers
Secondary hyperalgesia (hypersensitive pain)


Treatment:

3rd most complex Musculoskeletal disorder to treat after Frozen Shoulder and Plantar Fasciitis!

This is because of:

Inadequate Differential diagnosis (could be something else
Difficulty addressing all contributing factors (work, hobbies etc.)
Seen in chronic stages – lots of changes such as central changes in chronic pain
Biopsycholosocial issues

The evidence says:

  • Acupuncture
  • Steroid injection
  • NSAID’s
  • Surgery
  • Exercise therapy:
Salter et al 2010: Short low load exercises (eccentric or concentric) lowered pain levels
  • Deep Transverse Frictional Massage
  • Mobilisation With Movement (MWM's)
  • Cervical Lateral Glide mobilisation
  • Taping
Overall the research suggests:
MWM’s & exercise are the most beneficial
Cortico-Steroid Injection may be better in long term (but not significantly better)

Either way this injury is complicated and difficult to sort out but it can be, however it is very likely to take a long time, but as you can see Physiotherapy definitely helps.









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