Lateral epicondylitis
From Medical-Wiki
Lateral epicondylitis is also known as tennis elbow. While it has been known as a syndrome for decades, it has recently been elucidated with regard to its causes and pathophysiology. It would appear that the term “epicondylitis” is actually a misnomer. The term implies inflammation as the cause of problems. Recent studies have suggested that the tendons involved in lateral epicondylitis are not inflamed. Biopsies show fibroblastic and vascular response but no evidence of an immune reaction. Thus the term “teninosis” may be more accurate. However, this conclusion must be considered in light of the fact that inflammatory cells were found in the fibrous scar tissue surrounding the tendons. Further, acute lateral epicondylitis responds to anti-inflammatories. Thus, there is probably not an inflammatory response in the tendon, but there is one in the muscle and soft tissue around the tendon.
The lateral epicondyle of the humerus
The extensor carpi radialis brevis (ECRB), extensor digitorum communis, extensor carpi radialis longus, and extensor carpi ulnaris attach in an area over the lateral epicondyle of the humerus and just below the epicondyle. These are the wrist extensor and supinator muscles. Any activity that requires a wrist to snap or severely supinate stresses the attachment of these muscles. Sometimes this is because an athlete is being too active. Sometimes it is due to improper technique. Carpenters, jackhammer operators, people using hand-held power tools, production line workers, those playing string instruments, drummers, and those who work at computers or keyboards in a setting of poor ergonomics are all prone to lateral epicondylitis. [1]
Diagnosis and treatment of tennis elbow
Physical examination reveals tenderness and sometimes obvious swelling at the attachment of the muscles. In more severe cases, even shaking hands will produce pain.
One of the problems with this condition is the lack of high-quality clinical trials evaluating the many treatment modalities that are used. Watchful waiting, ultrasonography, iontophoresis with nonsteroidal anti-inflammatory drugs. topical nonsteroidal anti-inflammatory drugs, inelastic, nonarticular, proximal forearm straps, i.e. tennis elbow braces, and progressive resistance exercises all appear to have some effect in improving the condition. Basically, all treatment is an effort to reduce the stress on the point of tendinous attachment—even the activities of daily life. This is why the ongoing use of a forearm strap is exceedingly helpful. It basically functions to alter the fulcrum point of the muscles away from the epicondyle towards the body of the muscle. [2]
The modality that appears to offer the most dramatic improvement is local injection of corticosteroids. However, even this has not been subject to rigorous studies. [3]
There are federal guidelines outlining what modalities are considered appropriate, what are considered poorly studied, and those with no evidence to support their use. [4]
