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Lateral Epicondylitis

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Musculoskeletal Sports and Spine Disorders

Abstract

Lateral epicondylitis, or tennis elbow, is pain in the lateral (radial aspect) of the elbow that emanates from the common extensor hood. It is believed to be caused by inflammation or collagen instability initially, in the extensor carpi radialis brevis. Its most pathognomonic symptom is lateral elbow pain with wrist extension or power grip (when the wrist extensors fire). Pain may radiate down the forearm from the lateral elbow toward the wrist. The most common exam findings include pain in the lateral elbow with resisted wrist and finger extension known as Cozen’s maneuver. Most common treatment includes relative rest, physical therapy, ice, and NSAIDS. Various injection techniques are also useful, but some are believed to be controversial.

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References

  1. Arcury TA, Cartwright MS, Chen H, Rosenbaum DA, Walker FO, Mora DC. Musculoskeletal and neurological injuries associated with work organization among immigrant Latino women manual workers in North Carolina. Am J Ind Med. 2014 Apr;57(4):468–75.

    Article  Google Scholar 

  2. Whaley A, Baker CL. Lateral epicondylitis. Clin Sports Med. 2004;23(4):677–91, x.

    Article  Google Scholar 

  3. Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012;4(5):384–93.

    Article  Google Scholar 

  4. Nirschl R, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003;22(4):813–36.

    Article  Google Scholar 

  5. Martinez-Silvestrini JA, Newcomer KL, Gay RE, Schaefer MP, Kortebein P, Arendt KW. Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening. J Hand Ther. 2005;18(4):411–9, quiz 420.

    Article  Google Scholar 

  6. Brummel J, Baker 3rd CL, Hopkins R, Baker Jr CL. Epicondylitis: lateral. Sports Med Arthrosc. 2014;22(3):e1–6.

    Article  Google Scholar 

  7. Burnham R, Gregg R, Healy P, Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. Clin J Sport Med. 1998;8(2):78–81.

    Article  CAS  Google Scholar 

  8. Pattanittum P, Turner T, Green S, Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013;(5):CD003686.

    Google Scholar 

  9. Groppel J, Nirschl RP. A mechanical and electromyographical analysis of the effects of various joint counterforce braces on the tennis player. Am J Sports Med. 1986;14(3):195–200.

    Article  CAS  Google Scholar 

  10. Walther M, Kirschner S, Koenig A, Barthel T, Gohlke F. Biomechanical evaluation of braces used for the treatment of epicondylitis. J Shoulder Elb Surg. 2002;11(3):265–70.

    Article  Google Scholar 

  11. Burton A. Grip strength and forearm straps in tennis elbow. Br J Sports Med. 1985;19(1):37–8.

    Article  CAS  Google Scholar 

  12. Garg R, Adamson GJ, Dawson PA, Shankwiler JA, Pink MM. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elb Surg. 2010;19(4):508–12.

    Article  Google Scholar 

  13. Van De Streek M, Van Der Schans CP, De Greef MH, Postema K. The effect of a forearm/hand splint compared with an elbow band as a treatment for lateral epicondylitis. Prosthetics Orthot Int. 2004;28(2):183–9.

    Article  CAS  Google Scholar 

  14. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39(7):411–22; discussion 411–22.

    Google Scholar 

  15. Pienimaki T, Tarvainen T, Siira P, Vanharanta H. Progressive strengthening and stretching exercises and ultrasound for chronic lateral epicondylitis. Physiotherapy. 1996;82:522.

    Article  Google Scholar 

  16. Croisier J, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007;41(4):269–75.

    Article  Google Scholar 

  17. Tyler T, Thomas GC, Nicholas SJ, McHugh MP. Addition of isolated wrist extensor eccentric exercise to standard treatment for chronic lateral epicondylosis: a prospective randomized trial. J Shoulder Elb Surg. 2010;19(6):917–22.

    Article  Google Scholar 

  18. Nirschl R, Rodin D, Ochiai D, Maartmann-Moe C, DEX-AHE-01-99 Study Group. Iontophoretic administration of dexamethasone sodium phosphate for acute epicondylitis: a randomized, double-blinded, placebo-controlled study. Am J Sports Med. 2003;31(2):189–95.

    Article  Google Scholar 

  19. Runeson L, Haker E. Iontophoresis with cortisone in the treatment of lateral epicondylalgia (tennis elbow) – a double-blind study. Scand J Med Sci Sports. 2002;12(3):136–42.

    Article  CAS  Google Scholar 

  20. Grossi E, Monza GC, Pollavini S, Bona L. NSAID ionisation in the management of soft-tissue rheumatism: role played by the drug, electrical stimulation and suggestion. Clin Exp Rheumatol. 1986;4(3):265–7.

    CAS  PubMed  Google Scholar 

  21. Van der Windt D, van der Heijden GJ, van den Berg SG, ter Riet G, de Winter AF, Bouter LM. Ultrasound therapy for musculoskeletal disorders: a systematic review. Pain. 1999;81(3):257–71.

    Article  CAS  Google Scholar 

  22. Binder A, Hodge G, Greenwood AM, Hazleman BL, Page Thomas DP. Is therapeutic ultrasound effective in treating soft tissue lesions. Br Med J (Clin Res Ed). 1985;290(6467):512–4.

    Article  CAS  Google Scholar 

  23. Trinh KV, Phillips SD, Ho E, Damsma K. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology (Oxford). 2004;43(9):1085–90. Epub 2004 Jun 22.

    Article  CAS  Google Scholar 

  24. Bisset L, Beller E, Jull G, Brooks P, Darnell R, Vicenzino B. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333(7575):939. Epub 2006 Sep 29.

    Article  Google Scholar 

  25. Altay T, Günal I, Oztürk H. Local injection treatment for lateral epicondylitis. Clin Orthop Relat Res. 2002;398:127–30.

    Article  Google Scholar 

  26. Mishra A, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, et al. Efficacy of platelet-rich plasma for chronic tennis elbow a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42:463.

    Article  Google Scholar 

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Correspondence to Thomas Riolo DO .

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Riolo, T., Levchenko, A. (2017). Lateral Epicondylitis. In: Kahn, S., Xu, R. (eds) Musculoskeletal Sports and Spine Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-50512-1_18

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  • DOI: https://doi.org/10.1007/978-3-319-50512-1_18

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  • Online ISBN: 978-3-319-50512-1

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