Tennis Elbow

THE CLINICAL SYNDROME

Tennis elbow (known as lateral epicondylitis) is caused by repetitive microtrauma to the extensor tendons of the forearm. The pathophysiology of tennis elbow is initially caused by microtearing at the origin of extensor carpi radialis and extensor carpi ulnaris. Secondary inflammation may occur that can become chronic as the result of continued overuse or misuse of the extensors of the forearm. Coexistent bursitis, arthritis, and gout may also perpetuate the pain and disability of tennis elbow.

Tennis elbow occurs in patients engaged in repetitive activities that include hand grasping, such as shaking hands by politicians, or high torque wrist turning, such as scooping ice cream at an ice cream parlor. Tennis players develop tennis elbow via two separate mechanisms: (1) increased pressure grip strain as a result of playing with too heavy a racquet and (2) making backhand shots with a leading shoulder and elbow rather than keeping the shoulder and elbow parallel to the net. Other racquet sport players are also susceptible to the development of tennis elbow.

The pain of tennis elbow is located to lateral epicondyle

SIGNS AND SYMPTOMS

The pain of tennis elbow is localized to the region of the lateral epicondyle. It is constant and is made worse with active contraction of the wrist. Patients will note the inability to hold a coffee cup or hammer. Sleep disturbance is common. On physical examination, there will be tenderness along the extensor tendons at or just below the lateral epicondyle. Many patients wit tennis elbow will exhibit a bandlike thickening within the affected extensor tendons. Elbow range of motion will be normal. Grip strength on the affected side will be diminished. Patients with tennis elbow will demonstrate a positive tennis elbow test. The test is performed by stabilizing the patient’s forearm and then having the patient clench his or her fist and actively extend the wrist. The examiner then attempts to force the wrist into flexion. Sudden severe pain is highly suggestive of tennis elbow.

Palpation over the lateral epicondyle while the patient actively extends the wrist will elicit pain in patients with tennis elbow. Proper needle placement for tennis elbow.

TREATMENT

Initial treatment of the pain and functional disability associated with tennis elbow should include a combination of the nosteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Any repetitive activity that may exacerbate the patient’s symptomatology should be avoided. For patients who do not respond to these treatment modalities, the injection technique described here may be a reasonable next step.

Injection technique for tennis elbow is performed by placing the patient in a supine position with the arm fully adducted at the patient’s side and the elbow flexed with the dorsum of the hand resting on a folded towel to relax the affected tendons.

This injection technique is extremely effective in the treatment of pain secondary to the tennis elbow. Coexistent bursitis and tendonitis may also contribute to elbow pain and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate steroid.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age –related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.