Tennis Elbow

Objectives• Introduction to the topic •Anatomy of the elbow joint •Define Epicondylitis •Signs and symptoms •Causes •Pathophysiology •Prevention •Diagnosis •Treatment •Surgical Treatment

Introductionthe first description of the condition, in 1873 The term tennis elbow first appeared in an 1883 paper by Major called Lawn-tennis elbow.

Other names: Lateral epicondylitis lateral epicondylalgia known as :(tennis elbow, shooter's elbow, and archer's elbow or simply lateral elbow pain)

• elbow joint is made up of three bones: upper arm

bone (humerus) and the two bones in forearm (radius and ulna). There are bony

bumps at the bottom of the humerus called epicondyles.

The bony bump on the outside (lateral side) of the elbow is called the lateral

epicondyle.

• Muscles, ligaments, and tendons hold the elbow joint

together.

Anatomy

Epicondylitis: inflammation or microdamage to collagenous tissues on either lateral or medial side of the distal humurus.

• Lateral epicondylitis is known as “tennis elbow.” This injury is caused by chronic inflammation of the attachment of the extensor carpi radialis brevis and extensor digitorum to the lateral epicondyle.

Defi niti on

Signs and symptoms

• Pain on the outer part of the elbow (lateral epicondyle)

• Point tenderness over the lateral epicondyle—a prominent part of the bone on the outside of the elbow

• Pain from gripping and movements of the wrist, especially wrist extension and lifting movements

• Morning stiffness

Causes • overexertion • trauma such as direct blows to the epicondyle• a sudden forceful pull, or forceful extension

cause more than half of these injuries.• Unknown

• Decrease the amount of playing time if already injured or feeling pain in outside part of the elbow.

• Stay in overall good physical shape. • Strengthen the muscles of the forearm: (Pronator

quadratus,pronatorteres and supinator muscle)—the upper arm: (Biceps,triceps,deltoid muscle)—and the shoulder and upper back (trapezius). Increased muscular strength increases stability of joints such as the elbow.

• Like other sports, use equipment appropriate to your ability, body size, and muscular strength.

Prevention

Diagnosis• Physical examiation: the physician performs a battery of tests in which he

places pressure on the affected area while asking the patient to move the elbow, wrist, and fingers.

• X-rays: can confirm and distinguish possibilities of existing causes

of pain that are unrelated to tennis elbow, such as fracture or arthritis.

• Medical ultrasonographyand and magnetic resonance imaging (MRI) • Clinical signs and symptoms

Treatment • Equipment check: (in a racquet sport)

• Physical therapy: -Specific exercises are helpful for strengthening

the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.

- Wrist stretching exercise with elbow extended.

• Brace: can reduce symptoms by resting the muscles and tendons.

Treatment ‘cont

• Extracorporeal shock wave therapy: -These sound waves create "microtrauma" that

promote the body's natural healing processes. - Shock wave therapy is considered experimental by

many doctors, but some sources show it can be effective.

• However, Tennis elbow left untreated can lead to chronic pain that degrades quality of daily living

• Steroid injections: Steroids, such as cortisone, are very effective anti-inflammatory medicines.

Prognosis

• Response to initial therapy is common, but so is relapse (18% to 50%) and/or prolonged, moderate discomfort (40%).

Surgical Treatment • If your symptoms do not respond after 6 to 12

months of nonsurgical treatments, your doctor may recommend surgery.

• Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.

• The surgical approach depend on : - the scope of your injury -your general health and personal needs.

• Open surgery. The most common approach to tennis elbow repair is open surgery. This involves making an incision over the elbow.

• Arthroscopic surgery. Tennis elbow can also be repaired using tiny instruments and small incisions.

Surgical risks:• Infection• Nerve and blood vessel damage• Possible prolonged rehabilitation• Loss of strength• Loss of flexibility• The need for further surgery

Rehabilitation• arm immobilized temporarily with a

splint.

• About 1 week later, the sutures and splint are removed.

• Light, gradual strengthening exercises are started about 2 months after surgery

(to stretch the elbow and restore flexibility)

• return to athletic activity is usually 4 to 6 months after surgery.