Lateral Epicondylitis

lateral epicondylitis

 

lateral epicondylitis

lateral epicondylitis

Lateral Epicondylitis Description
Lateral epicondylitis is more commonly called tennis elbow.  Tennis elbow causes pain in the outside of the elbow which often radiates into the forearm and is typically insidious in onset.  People who have tennis elbow typically have a history of repetitive activity such as tennis, squash, racquetball, fencing, meat cutting, plumbing, painting, raking, carpentry, typing, knitting, machine work, or weaving.

Tennis elbow occurs in males and females equally.  The incidence is 2-3.5 times greater in tennis players with over 2hrs of racket time per week than those with less than 2 hrs per week.   It affects 10-50% of tennis players.  The typical patient with lateral epicondylitis is in the  4th to 5th decade of life.  It affects 1-3% of adults/year and is more common in the dominant arm.

Lateral Epicondylitis Anatomy
Lateral epicondylitis is believed to be initiated by a microtear, most often within the origin of the extensor carpi radialis brevis muscle on the outside of the elbow.  The tear may originate in any muscle originating from the epicondyle.  Pathologic studies have demonstated angiofibroblastic hyperplasia of the involved tissue demonstrating fibroblast proliferation, neovascularization and hyaline degeneration without acute inflammatory cells.

Lateral Epicondylitis Symptoms
Lateral epicondylitis causes pain and tenderness on the outer side of the elbow.  The pain is typically worse with the wrist or fingers are straightened (extended).  The pain may shoot up into the arm or down into the forearm.  

Lateral Epicondylitis Treatment
Lateral Epicondylitis is diagnosed based on a detailed history, physical exam and xrays performed by an orthopaedic surgeon, or sports medicine specialist. 

Initial treatment for Lateral Epicondylitis is centered around cessation of the offending activity.  Ice, NSAIDs and a counterforce brace placed over the forearm musculature are typically beneficial.  Icing is best done 3 times per day for 20 minutes.  The best way to ice tennis elbow is using a Cryocup Ice Massage or Dixie cup of ice applied directly to the lateral epicondyle.  NSAIDS such as motrin or naproxen are beneficial. Secondary treatment options include: corticosteriod injections, Platelet-rich plasma injection, Ultrasound, and surgery.    Other treatments such as Botulinum toxin injection and Shock wave therapy / ESWT have been shown to have little or no benefit.

Athletes returning to sports after Lateral Epicondylitis should begin with a graduated exercise program.  First they should be pain free with daily activities with full range of motion and at least 85% strength in the injured extremity compared to the uninjured extremity.  

Lateral Epicondylitis Prevention
Prevention of Lateral Epicondylitis begins with adequate warm ups well before play or intense exercise. Muscles and tendons stretch more when they are warm and your blood is flowing. Ensure your racquet handle and grip is not too big or too small. Rackets must be properly maintained and strung appropriately. Not too tight or too loose. Rackets with very large heads can increase the stress on the elbow as well.

If the lateral epicondyle is tennis related, review your technique and swing with a tennis coach. Poor technique can exacerbate shoulder and elbow problems.

Lateral Epicondylitis Risk Factors
Lateral Epicondylitis is associated the following sports: Baseball, Basketball, Boxing, Cycling, Dance, Diving, Equestrian, Figure Skating, Football, Golf Injury, Gymnastics, Hockey, Rowing, Rugby, Running, Skiing, Snowboarding, Soccer, Swimming, Tennis, Volleyball, Weight Lifting, Wrestling. It is more common in athletes who are poorly conditioned and do not adequately warm-up prior to their sporting activities.  

Lateral Epicondylitis Rehab and Exercise Program

Lateral Epicondylitis Outcomes

Similar injuries that can be confused with Lateral Epicondylitis include:
Posterolateral synovial plica
Cerival disease with radiculopathy
Intraarticular elbow loose body
Elbow arthritis
Posterolateral rotatory instability
Olecranon bursitis
Posterior olecranon impingement
PIN entrapment
Radial Tunnel syndrome
Radiocapitellar osteochondral lesions.

synonyms: Tennis Elbow, lateral epicondylitis, common extensor tear, common extensor tenosynovitis, extensor carpi radialis brevis tear

 

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