Tennis elbow(Lateral Epicondylitis)

Tennis elbow(Lateral Epicondylitis)

tennis elbow is a very common clinical entity seen as a pain and tenderness in the common origin from the extensor group muscles from the forearm,usually due to a specific strain, overuse, or perhaps a direct bang.It's considered a cumulative trauma injury occurring over time from repeated utilisation of the muscles of the arm and forearm, resulting in small tears from the tendons (Tendonitis).The condition that's commonly associated with playing tennis along with other racket sports, though the injury may happen to almost anybody.

The tendinous origin of extensor carpi radialis brevis (ECRB) may be the area of most pathologic changes. Changes can be found at musculotendinous structures from the extensor carpi radialis longus, extensor carpi ulnaris and extensor digitorum communis. Overuse and repetitive trauma in this region causes fibrosis and micro tears within the involved tissues. Nirschl known the micro tears and also the vascular in development of the involved tissues as angiofibroblastic hyperplasia. A tear occurs in the teno-muscular junction, in the tendon, or in the teno-periosteal junction. The resulting inflammation produces exudate by which fibrin forms to heal the torn tissue.Repeated activity causes micro trauma, with subsequent granulation tissue formation around the underside of the tendon unit and also at the teno-periosteal junction. The granulation tissue formed seems to contain large number of free nerve endings, hence the pain sensation of the condition. The issue is that the granulation tissue doesn't progress quickly to some mature form, and thus healing fails to occur, almost a type of tendinous 'nonunion'.

Reason for tennis elbow

The most typical cause of Lateral Epicondylitis in tennis players is really a 'late' mechanically poor backhand, that places excess force over the extensor wad, that is, the elbow leads the arm. Other allies include incorrect grip size,string tension, poor racket dampening, and underlying weak muscles from the shoulder,elbow and arm.Tennis grips which are too small often exacerbate or cause tennis elbow. Normally a history of repetitive flexion-extension or pronation-supination activity and overuse is obtained (eg.,twisting a screwdriver, lifting heavy luggage using the palm down). Tightly gripping huge briefcase is a very common cause.Raking leaves, baseball, golfing, gardening, and bowling may also cause Lateral Epicondylitis. Less commonly,tendonitis is only a result of single acute injury.

Clinical Presentation

In the beginning, the athlete might be aware of only fatigue and spasm of dorsal forearm muscles associated with unaccustomed activity. They may note the start of aching lateral elbow pain after playing. Eventually the pain sensation may become so constant and severe in order to stop the athlete from further playing and also to interfere with activities of everyday living, such as carrying a briefcase, wringing wet clothes as well as holding a cup of tea. Grip becomes weak.Morning stiffness might be felt.

 Examination

-Point tenderness over or simply distal to the lateral humeral epicondyle (the bony attachment from the common extensor tendon) which provides rise to burning sensation when pressure is used.

Tenderness over muscles of dorsal forearm.

Pain with resisted wrist extension, finger extension and resisted radial deviation.

Pain with passive stretching of wrist extensors.

With traditional symptoms, there is apt to be considerable atrophy and weakness of extensor muscles and limitation of passive wrist flexion. Accessory movements from the elbow and superior radio-ulnar joint might be reduced in along term problem.

Special tests for tennis elboW

1)Cozen's test- The patient's elbow is stabilized through the examiner's thumb, which rests around the patient's lateral epicondyle. The individual is then asked to create a fist, pronate the forearm and radially deviate and extend the wrist as the examiner resists the motion. An optimistic sign is shown by sudden severe pain in the region of lateral epicondyle from the humerus.

2)Mill's test-While palpating the lateral epicondyle, the examiner pronates the patient's forearm, and flexes the wrist fully and extends the elbow. An optimistic test is shown by pain over the lateral epicondyle of humerus.

3)Maudsley's test- The examiner resists extension from the 3rd digit from the hand, stressing the extensor digitorum muscle and tendon. An optimistic test is shown by pain over the lateral epicondyle from the humerus.

Differential Diagnosis

Evaluation should note possible sensory paresthesias within the superficial radial nerve distribution to eliminate Radial tunnel syndrome.It's the most common cause of refractory lateral pain and coexists with Lateral Epicondylitis in 10% of the sufferers.

The cervical nerve roots ought to be examined to rule out cervical radiculopathy.

Other concerns that should be considered include bursitis from the bursa below the conjoined tendon, chronic irritation from the radiohumeral joint or capsule, radiocapitellar chondromalacia or arthritis, radial neck fracture, panner's disease, little league elbow and osteochondritis dissecans from the elbow.

 Investigations

X-rays aren't necessary. Rarely, magnetic resonance imaging (MRI) scans enables you to show changes in the tendon to begin of attachment to the bone. MRI typically shows fluid within the ECRB origin. There may also be a defect within this tissue. The use of the term "tear" to refer to this defect could be misleading. The word "tear" implies injury and also the need for repair--both of which are most likely inaccurate and inappropriate for this degenerative enthesopathy.

Conservative treatment of tennis elbow

Activity Modification

-In non-athletes, removal of activities that are painful is essential to improvement (eg., repetitive valve opening).

PRICE METHOD..