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Lateral epicondylitis

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In medicine, lateral epicondylitis, also called tennis elbow, is "a condition characterized by pain in or near the lateral humeral epicondyle or in the forearm extensor muscle mass as a result of unusual strain. It occurs in tennis players as well as housewives, artisans, and violinists."[1] Carpenters who do a lot of hammering are also susceptible to it; it also can come from computer overuse, especially of a mouse. In other words, it may be caused either by a single event, or it may be a cumulative trauma disorder. Cumulative injury is more common.

Mechanism of injury

It appears to be caused by "repetitive and forceful forearm supination and pronation, as well as overuse or weakness (or both) of the extensor carpi radialis brevis (ERCB) and extensor carpi radialis longis muscles of the forearm, which originate from the lateral epicondyle of the elbow."[2] It may also involve the extensor digitorum, and extensor carpi ulnaris.

The radial nerve splits into the superficial radial nerve and posterior interosseus nerve (PIN) at the radiocapitellar joint. If the PIN is entrapped by pericapsular structures, lateral epicondylitis can cause radial tunnel syndrome.

Prevention

Diagnosis

It is most common in patients between 40 and 60 years of age, often with pain beginning 24-72 hours after especially active wrist use. Pain is worst over the lateral elbow, may radiate down the posterior forearm, and the patient can often identify the origin of the pain as 1.5 cm distal to the origin of the ECRB. "Pain can vary from being mild (eg, with aggravating activities like tennis or the repeated use of a hand tool), or it can be such severe pain that simple activities like picking up and holding a coffee cup (ie, "coffee cup sign") will act as a trigger for the pain."[3]

Treatment

The role of exercises is not clear.[4] A sometimes efficacious means for tennis players to combat it is to change tennis rackets, moving to a much smaller size of the handle, thereby reducing the tension needed to grip it.

The role of orthotic devices is not clear.[5]

Corticosteroid injections may offer the best relief after 6 weeks, but due to relapses, conservative therapy may be best after a year.[6][7]

Botulinum toxin may reduce pain.[8]

References

  1. Anonymous (2020), Lateral epicondylitis (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Lateral Epicondylitis (Tennis Elbow), Merck Manual for Medical Professionals
  3. Walrod BJ, Young CY (23 July 2009), "Lateral Epicondylitis", eMedicine: specialties (Sports Medicine)
  4. Bisset L, Paungmali A, Vicenzino B, Beller E (2005). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia.". Br J Sports Med 39 (7): 411-22; discussion 411-22. DOI:10.1136/bjsm.2004.016170. PMID 15976161. PMC PMC1725258. Research Blogging.
  5. Struijs PA, Smidt N, Arola H, Dijk CN, Buchbinder R, Assendelft WJ (2002). "Orthotic devices for the treatment of tennis elbow.". Cochrane Database Syst Rev (1): CD001821. DOI:10.1002/14651858.CD001821. PMID 11869609. Research Blogging.
  6. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B (2006). "Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial.". BMJ 333 (7575): 939. DOI:10.1136/bmj.38961.584653.AE. PMID 17012266. PMC PMC1633771. Research Blogging. Review in: J Fam Pract. 2007 Feb;56(2):98 Review in: Evid Based Med. 2007 Apr;12(2):39
  7. Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM (2002). "Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial.". Lancet 359 (9307): 657-62. DOI:10.1016/S0140-6736(02)07811-X. PMID 11879861. Research Blogging. Review in: ACP J Club. 2002 Sep-Oct;137(2):65
  8. Wong SM, Hui AC, Tong PY, Poon DW, Yu E, Wong LK (2005). "Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial.". Ann Intern Med 143 (11): 793-7. PMID 16330790.