Tennis elbow , also known as lateral epicondylitis , is a condition in which the outside of the elbow becomes painful and tender. The pain may also extend to the back of the forearm and the strength of the grip may be weak. The onset of symptoms is generally gradual. Golfer Elbow is a similar condition that affects the inside of the elbow.
This is because the use of the back muscles of the forearm is excessive. Usually this happens as a result of work or sport of classic racquet sports. Diagnosis is supported if pain increases when someone tries to bend their wrist back with both their hands held in a neutral position. It is classified as chronic tendinosis rather than tendinitis.
Treatment involves a decrease in activity that brings symptoms along with physical therapy. Pain medications such as NSAIDS or acetaminophen may be used. If the condition does not increase corticosteroid injections or surgery may be recommended. Those aged 30 to 50 years are most often affected.
Video Tennis elbow
Signs and symptoms
- Pain on the outside of the elbow (lateral epicondyle)
- Direct the tenderness of the lateral epicondyle - the protruding part of the bone on the outside of the elbow
- Pain in grasping and wrist movement, especially wrist extension (eg turning a screwdriver) and lifting movements
Symptoms associated with tennis elbow include, but are not limited to: radiating pain from the outside of the elbow to the forearm and wrist, pain during wrist extension, weakness of the forearm, painful grip when shaking hands or torquing the doorknob, and can not holding a relatively heavy item in hand. The pain is similar to the condition known as the golfer's elbow, but the latter occurs on the medial side of the elbow.
Terminology
The term "tennis elbow" is used extensively (although informally), but this condition should be understood not to be limited to tennis players. The medical term "lateral epicondylitis" is most commonly used for this condition.
Because histologic findings reveal noninflammatory tissue, the term "lateral elbow tendinopathy," "tendinosis," or "angio-fibroblastic tendinosis" has been suggested as a substitute for lateral epicondylitis.
Maps Tennis elbow
Cause
Tennis elbow is a type of repetitive strain injury due to overused tendons and failed tendon healing. In addition, the extensor muscle carpi radialis brevis plays a key role.
Initial experiments show that tennis elbow is mainly caused by fatigue. However, research shows that trauma such as a direct blow to the epicondyle, a sudden strong pull, or strong extension causes more than half of these injuries. Repeatedly hitting a tennis ball in the early stages of sports learning causes a shock to the elbow joint and may cause contractions in the condition.
Pathophysiology
Histologic findings include granulation tissue, microrupture, degenerative changes, and no traditional inflammation.
The longitudinal sonogram of the lateral elbow exhibits thickening and heterogeneity of general extensor tendons consistent with tendinosis, since ultrasound reveals calcification, intracubstique tears, and marked lateral epicondyle occlusion. Although the term "epicondylitis" is often used to describe this disorder, most histopathological findings from the study do not show acute evidence, or chronic inflammatory processes. Histologic studies have shown that this condition is the result of tendon degeneration, which replaces normal tissue by irregular collagen regulation. Therefore, this disorder is more properly referred to as tendinosis or tendinopathy rather than tendinitis.
Doppler color ultrasound reveals structural tendon changes, with vascularization and hypo-echoic areas corresponding to the extensor pain area.
The pathophysiology of lateral epicondylitis is degenerative. Non-inflammatory chronic degenerative changes of the extensor carpi radialis brevis (ECRB) muscle are identified in surgical pathology specimens. It is unclear whether pathology is affected by previous corticosteroid injections.
Tennis players generally believe that tennis elbows are caused by repeated traits to hit thousands of tennis balls, which cause small tears on the forearm of the attachment tendon at the elbow.
The extensor digiti minimi also has a small site medial to the elbow that can affect this condition. Muscles involve the extension of the little finger and some wrist extensions allow for adaptation to "snap" or flick the wrist - usually associated with a racket swing. Most often, extensor muscles become painful because of tendon damage from over-extension. Improper form or movement allows the power in the swing to rotate through and around the wrist - creating a moment on the joint instead of the elbow joint or rotator cuff. This moment causes pressure to build impaction forces to act on tendons that cause irritation and inflammation.
Some advocate exaggerated theories that advance the extensor carpi radialis brevis has a small origin and sends great power through its tendons during repeated loops. It has also been implicated as susceptible during shear stress during all the forearm movement.
At least one writer questioned that lateral epicondylitis is caused by repetitive/exaggerated microtrauma, maintaining theories tend to be exaggerated and lacking scientific support.
Other speculative risk factors for lateral epicondylitis include taking tennis in later life, unaccustomed weight activity, decreased mental chronometry and recurrent eccentric muscle velocity and contraction (controlled elongation of muscle groups).
Diagnosis
Physical exam
To diagnose tennis elbow, doctors perform a battery test in which they put pressure on the affected area when asking the patient to move the elbow, wrist, and fingers. Diagnosis is made by discrete and distinctive clinical signs and symptoms. For example, when the elbow is fully elongated, the patient feels the point of tenderness above the affected point at the elbow. The most common location of pain originates from the extensor muscle carpi radialis brevis of the lateral epicondyle (extensor carpi radialis brevis origin), 1 cm distal and slightly anterior lateral epicondyle. There is also pain with passive wrist flexion and resistive wrist extension (Cozen test).
Radiographic imaging
X-rays can confirm and distinguish possible causes of existing pain that are not associated with tennis elbow, such as fractures or arthritis. Rarely, calcification can be found in which the extensor muscle attaches to the lateral epicondyle. Medical ultrasonography and magnetic resonance imaging (MRI) are another valuable tool for diagnosis but are often avoided because of their high cost. An MRI examination may confirm excess fluid and swelling in the affected area of ​​the elbow, such as the connecting point between the forearm bone and the extension of the carpi radialis brevis muscle.
Prevention (tennis)
Where lateral epilondylitis is caused by playing tennis, another factor of tennis elbow injury is experience and ability. The proportion of players reporting tennis elbow history has an increasing number of years of play. As for ability, poor technique increases the chance for injuries like sports. Therefore, an individual must learn the right techniques for all aspects of their sport. The competitive level of the athlete also affects the occurrence of tennis elbow. Class A and B players have significantly higher levels of elbow on the elbow compared to class C and beginner players. However, contrary, but not statistically significant, trends were observed for previous case recurrences, with an increasingly high rate when the level of ability decreased.
Other ways to prevent tennis elbow:
- Decrease the amount of play time if it has been injured or felt pain on the outside of the elbow.
- Stay in good physical shape overall.
- Strengthen the muscles of the forearm: (pronator quadratus, pronator teres, and supinator muscle) - upper arm: (biceps, triceps) - and shoulders (deltoid muscle) and upper back (trapezius). Increased muscle strength improves joint stability such as elbows.
- Like any sport, use equipment that suits your abilities, body size, and muscle strength.
- Avoid repeated appointments or heavy object pullouts (especially above your head)
Vibration dampers (otherwise known as "gummies") are not believed to be a reliable measure of prevention. Conversely, the proper weight distribution in the racket is considered to be a more viable option in negating the shock.
Treatment
Evidence for the treatment of lateral epicondylitis before 2010 is poor. There are clinical trials addressing many of the proposed treatments, but poor quality trials.
In some cases, the severity of the tennis elbow symptoms improves without any treatment, within six to 24 months. An untreated tennis court can cause chronic pain that lowers the quality of everyday life.
Physical therapy
There are several recommendations on the most speculative prevention, treatment, and avoidance of recurrence including stretching and progressive strengthening exercises to prevent tendon irritation and other exercise actions.
One way to help handle a small tennis elbow case is to simply loosen the affected arm. The rest allows stress and stiffness in the forearms to slowly relax and eventually have the arm in working condition - within a day or two, depending on the casing.
Eccentric exercises using rubber rods are very effective for relieving pain and increasing strength. This exercise involves grasping a rubber rod, twisting it, then slowly turning it around. Although it may be considered evidence-based practice, long-term results have not been determined.
Moderate evidence suggests that joint manipulation is directed at the elbows and wrists and spinal manipulation directed at the cervical spine and thoracic regions resulting in clinical changes to pain and function. There is also moderate evidence for short and medium-term effectiveness of cervical spine and chest manipulation as additional therapy for concentric and eccentric stretching plus wrist and forearm mobilization. Although not conclusive, short-term analgesic effects of manipulation techniques may allow for stronger stretching and strengthening exercises, resulting in a better and faster recovery process of the affected tendon in lateral epicondylitis.
Low level laser therapy, given at certain doses and wavelengths directly to the lateral elbow tendon insertion, offers short-term and less defective pain relief in the elbow of tennis, both alone and along with a sports regimen. Recently, dry skewers have gained popularity to treat different types of tendinopathies and pain that come from muscles. Even in lateral epicondylitis, dry punctures are widely used by physical therapists around the world. Proponents believe that dry needling causes small local injuries that carry the desired growth factors around it. Dry needle is also aimed at generating a localized twitch response (LTR) in the extensor muscle - as in some cases the elbow's underarm muscle elbow will be the trigger point, which can be a major source of pain.
Orthotic Devices
Orthosis is a tool used externally on the extremities to improve function or reduce pain. Orthotics is a useful therapeutic intervention for early tennis elbow therapy. There are two main types of orthoses that are prescribed for this problem: orthosis counter force elbow and wrist extension orthosis.
Counterforce orthosis has a circular structure around the arm. This orthosis usually has a strap that implements a binding force over the origin of the wrist extensor. The force applied by orthosis reduces the elongation in musculotendinous fibers. Wrist extensor orthosis maintains the wrist with slight extension. This position reduces the tension of overloading in the lesion area.
Studies show both types of orthoses improve hand function and reduce pain in people with tennis elbow.
Medication
Although anti-inflammatory is a commonly prescribed treatment for tennis elbow, evidence of its effect is usually anecdotal with only limited research showing benefits. A systematic review found that a topical non-steroidal anti-inflammatory drug (NSAID) can improve pain in the short term (up to 4 weeks) but can not draw firm conclusions due to methodological problems. Evidence for oral NSAID is mixed.
Bad evidence for long-term repair of any type of injections, whether corticosteroids, botulinum toxin, prolotherapy or other substances. Corticosteroid injections may be effective in the short term but are of little use after one year, compared with the wait and see approach. A recent randomized controlled trial comparing the effects of corticosteroid injection, physiotherapy, or a combination of corticosteroid injections and physiotherapy found that patients treated with corticosteroid injections compared with placebo had a complete recovery or improvement that was lower at 1 year (Relative risk of 0, 86). Patients who received corticosteroid injections also had a higher recurrence rate at 1 year compared with placebo (54% versus 12%, relative risk 0.23). Complications of recurrent steroid injections include skin problems such as hypopigmentation and fatty atrophy that cause skin curvature around the injection site. Type A botulinum toxins to paralyze the extensor muscles of the forearm on those with chronic tennis elbow that have not improved with conservative measures may be feasible.
Surgery
In case of stubborn operation may be an option. Surgical methods include:
- Extend, release, debridement, or repair the origin of extrinsic extensor muscle of the hand on the lateral epicondyle
- Anconeus muscle rotation
- Lateral epicondyle denervation
- Posterior interoseus nerve decompression
Surgical techniques for lateral epicondylitis may be performed by open surgery, percutaneous surgery or arthroscopic surgery, with no evidence that a particular type is better or worse than the other.
Prognosis
Response to initial therapy is common, but so does relapses (25% to 50%) and/or prolonged, moderate discomfort (40%).
Depending on the severity and quantity of multiple tendon injuries that have been established, the extension carpi radialis brevis may not be completely cured by conservative treatment. Nirschl defines four stages of lateral epicondylitis, indicating the introduction of permanent damage beginning in Phase 2.
- Reversible inflammatory changes
- Non-reversible pathological changes to the origin of extensor carpi radialis brevis muscle
- Rupture of ECRB muscle origin
- Secondary changes such as fibrosis or calcification.
Epidemiology
In tennis players, about 39.7% have reported current or previous problems with their elbows. Less than a quarter (24%) of athletes under age 50 reported that tennis elbow symptoms were "severe" and "paralyzing," while 42% were over 50. More women (36%) than men (24%) regarded symptoms they are heavy and paralyzing. Tennis elbow is more common in people over the age of 40, where there is a fourfold increase among men and a twofold increase among women. Tennis elbow equally affects both sexes and, although men have overall overall prevalence rates lower than women, this is not consistent in every age group, nor is it a statistically significant difference.
Play time is a significant factor in the occurrence of tennis elbow, with increased incidence with increased play time being greater for respondents under 40 years. Individuals over the age of 40 who play more than two hours double their chances of injury. Those under 40 increased 3.5-fold compared with those who played less than two hours per day.
History
German physician F. Runge is usually credited for the first description of the condition, calling it "writer cramp" ( Schreibekrampf ) in 1873. Then, it is called "female washing machine poem". British surgeon Henry Morris published an article in The Lancet describing the "grass tennis arm" in 1883. The term "popular tennis elbow" first appeared that same year in a paper by HP Major, which is described as "lawn tennis elbow".
See also
- Golfer's elbow
- Olecranon bursitis
- Tendinitis
- Tendinosis
- Repetitive strain injury
- Radial tunnel syndrome
References
Further reading
Wilson JJ, Best TM (September 2005). "Excessive tendon problems are common: Reviews and recommendations for treatment". American Family Doctor . 72 (5): 811-8. PMID: 16156339.
External links
- Epicondylitis.org.uk - Tennis Elbow
- James Heilman MD, CCFP-EM, Wikipedian
Source of the article : Wikipedia
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