Tennis elbow ICD-10 M77.1 ICD-9 726.32 Tennis elbow (or lateral epicondylitis -- lat. epicondylitis lateralis humeri) is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Whilst it is called "tennis elbow", it should be noted that it is by no means restricted to tennis players. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to the complaint. The condition was first described in 1883.[1] Contents 1 Aetiology 2 Symptoms 3 Treatment 3.1 Initial measures 3.2 Local steroid injections 3.3 Surgical intervention 3.4 Alternative treatments 4 References 5 External links Aetiology With tennis elbow, the common extensor tendon origin at the lateral epicondyle of the humerus is irritated, inflamed, damaged and potentially torn. Men and women are equally affected and there are two typical patterns of occurrence: as an acute onset typically seen in young athletes, and as a chronic condition seen in older people.[1] Those tennis players with harder, more forceful serves feel gradually worsening pain after ten to twenty serves have been hit. The stress on the elbow can be great due to the centrifugal force applied to it. This force can, over a short period of minutes, develop into the specific problem known as tennis elbow. Symptoms Outer part of elbow (lateral epicondyle) tender to touch. Lateral elbow pain radiating to extensor aspect of the forearm. Movements of the elbow or wrist hurt, especially lifting movements. Exquisite tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee. Pain usually subsides overnight. If no treatment given, can become chronic and more difficult to eradicate. Treatment Although not founded in clinical research[2] , the tennis player's treatment of choice is frequent icing for inflammation, and taking ibuprofen anti-inflammatory pain-killers. In general the evidence base for intervention measures is poor.[3] A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain Initial measures Rest and ice are the treatment of choice. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation. Stretches and strengthening exercises are essential to prevent re-irritation of the tendon[4] . Splints may be helpful if the tendon is torn. With physiotherapy, ultrasound can be used to reduce the inflammation. Manual therapy (a form of physiotherapy) is an important part of the treatment; it helps to relieve the muscle spasm and helps to stretch out the tightened tissues. Local steroid injections Intra-articular glucocorticoid steroid injections can resolve episodes for several months, but there is a risk of later recurrence. Following an injection, the patient normally experiences increased pain over the subsequent day before the steroid starts to settle the condition over the next few days[5] . As with any steroid injection, there is a small risk of local infection and tendon rupture. Most doctors will restrict after two injections giving further courses, as there is less likelihood of effectiveness but increased risk of side-effects. As opposed to short-term effects[6] , the longterm benefits of local steroid injection are less clearly established.[7] Surgical intervention If conservative measures fail, release of the common extensor origin may be helpful. Alternative treatments Acupuncture has been proven to be beneficial.[8] References ^ a b Kaminsky SB, Baker CL Jr (2003). "Lateral epicondylitis of the elbow". Tech Hand Up Extrem Surg 7 (4): 179-89. PMID 16518219. ^ Manias P, Stasinopoulos D (2006). "A controlled clinical pilot trial to study the effectiveness of ice as a supplement to the exercise programme for the management of lateral elbow tendinopathy". Br J Sports Med 40 (1): 81-5. PMID 16371498 abstract. ^ Bisset L, Paungmali A, Vicenzino B, Beller E (2005). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia". Br J Sports Med 39 (7): 411-22; discussion 411-22. PMID 15976161 abstract. ^ Stasinopoulos D, Stasinopoulou K, Johnson MI (2005). "An exercise programme for the management of lateral elbow tendinopathy". Br J Sports Med 39 (12): 944-7. PMID 16306504 abstract. ^ Lewis M, Hay EM, Paterson SM, Croft P (2005). "Local steroid injections for tennis elbow: does the pain get worse before it gets better?: Results from a randomized controlled trial". Clin J Pain 21 (4): 330-4. PMID 15951651. ^ Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W (2002). "Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults". Cochrane Database Syst Rev (2): CD003686. PMID 12076503. ^ Altay T, Gunal I, Ozturk H (2002). "Local injection treatment for lateral epicondylitis". Clin Orthop Relat Res (398): 127-30. PMID 11964641. ^ Jiang ZY, Li CD, Guo JH, Li JC, Gao L (2005). "[Controlled observation on electroacupuncture combined with cake-separated moxibustion for treatment of tennis elbow]". Zhongguo Zhen Jiu 25 (11): 763-4. PMID 16335198. External links Wilson JJ, Best TM (2005). "Common overuse tendon problems: A review and recommendations for treatment". Am Fam Physician 72 (5): 811-8. PMID 16156339} Full article PDF. Medinfo article on Tennis elbow Tennis Elbow treatments and exercises Good resource on tennis elbow with diagrams Tennis elbow on orthopedics.about.com BBC Sport Academy: What is tennis elbow? "Tennis elbow:Even cricketers and housewives can get it" - Times of India article dated September 4, 2004 explaining tennis elbow following Sachin Tendulkar contracting it Retrieved from "http://en.wikipedia.org/wiki/Tennis_elbow" Categories: Inflammations | Overuse injuries | Tennis terminology