Tennis elbow

QU LIUXIN

SOUTHEAST UNIVERSITY ZHONGDA HOSPITAL

 Tennis elbow is a condition where the outer part of the elbow becomes sore and tender. It is a condition that is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody. The condition is more formally known as lateral epicondylitis ("inflammation to the outside elbow bone"), lateral epicondylosis, or simply lateral elbow pain.

Symptoms
Pain on the outer part of elbow (lateral epicondyle). Point tenderness over the lateral epicondyle a prominent part of the bone on the outside of the elbow. Gripping and movements of the wrist hurt, especially wrist extension and lifting movements. Activities that uses the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful. Morning stiffness.

Etiology
The strongest risk factor for lateral epicondylosis is age. The peak incidence is between 30 to 60 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated. The pathophysiology of lateral epicondylosis is degenerative. Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis muscle are identified in surgical pathology specimens. It is unclear if the pathology is affected by prior injection of corticosteroid. Among tennis players, it is believed to be caused by the "repetitive nature of hitting thousands and thousands of tennis balls" which lead to tiny tears in the forearm tendon attachment at the elbow.

 The following speculative rationale is offered by proponents of an overuse theory of etiology: The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm. While it is commonly stated that lateral epicondlyosis is caused by repetitive microtrauma/overuse, this is a speculative etiological theory with limited scientific support that is likely overstated. Other speculative risk factors for lateral epicondylosis include taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).

 Cervical spondylopathy

Exams and tests

The diagnosis is made by clinical signs and symptoms, which are usually both discrete and characteristic. There should be point tenderness over the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (ECRB origin). There should also be pain with passive wrist flexion and also with resisted wrist extension (Cozen's test), both tested with the elbow extended. MRI typically shows fluid in the ECRB origin. There may also be a defect in this tissue. The use of the word "tear" to refer to this defect can be misleading. The word "tear" implies injury and the need for repair-both of which are probably inaccurate and inappropriate for this degenerative enthesopathy.

Treatment
Acupuncture, soft tissue massage Local injection of cortisone and a numbing medicine Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen or aspirin

 Thumb pressing manipulation on C5, C6 transverse process