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Tenis elbow
1. Tennis elbow
Dr . Hasan Ali Talukder M.B.B.S,
FCPS,Anaesthesiologist, Dhaka
Medical College Hospital
2. Introduction
• Tennis elbow, also known as lateral
epicondylitis, is caused by repetitive
microtrauma to the extensor tendons of the
forearm.
3. Introduction
The most common nidus of pain from tennis
elbow is the bony origin of the extensor
tendon of extensor carpi radialis brevis at the
anterior facet of the lateral epicondyle.
Less commonly, tennis elbow pain can originate
from the extensor carpi radialis longus at the
supracondylar crest,
4. pathophysiology
• The pathophysiology of tennis elbow is
initiated by micro-tearing at the origin of
extensor carpi radialis and extensor carpi
ulnaris .
• Secondary inflammation may occur and can
become chronic .
• Coexisting bursitis, arthritis, and gout may
also perpetuate the pain and disability of
tennis elbow
5. prevelence
Tennis elbow occurs in patients engaged in
repetitive activities that include hand
grasping (e.g., politicians shaking hands) .
Tennis players develop tennis elbow by two
separate mechanisms: (1) increased pressure
grip strain and (2) making backhand shots
with a leading shoulder and elbow .
6. Clinical features
The pain of tennis elbow is localized to the
region of the lateral epicondyle. It is constant
and is made worse by active contraction of the
wrist. Sleep disturbance is common.
On physical examination, patients report
tenderness along the extensor tendons at, or
just below, the lateral epicondyle. Elbow range
of motion is normal. Grip strength on the
affected side is diminished.
7. Examination
tennis elbow test. The test is performed by
stabilizing the patient's forearm and then
having the patient clench his or her fist and
actively extend the wrist.The examiner then
attempts to force the wrist into flexion .
Sudden, severe pain is highly suggestive of
tennis elbow.
8. Investigation
Electromyography helps to distinguish cervical
radiculopathy and radial tunnel syndrome from
tennis elbow.
Plain radiographs are indicated in all patients who
present with tennis elbow, to rule out joint mice
and other occult bony disorders.
Based on the patient's clinical presentation,
additional testing including complete blood
count, uric acid, sedimentation rate, and
antinuclear antibody testing may be indicated.
9. Investigation
• Magnetic resonance imaging scan of the
elbow is indicated if joint instability is
suspected or if the patient's pain fails to
respond to traditional treatment modalities .
• The injection technique described
subsequently serves as both a diagnostic and
a therapeutic maneuver.
10. Differential diagnosis
Radial tunnel syndrome and occasionally C6-7
radiculopathy can mimic tennis elbow.
In radial tunnel syndrome, the maximal
tenderness is distal to the lateral epicondyle
over the radial nerve,
whereas in tennis elbow, the maximal
tenderness to palpation is over the lateral
epicondyle.
11. Treatment
Initial treatment include a combination of the
nonsteroidal anti-inflammatory agents or
cyclooxygenase-2inhibitors and physical therapy.
The local application of heat and cold may also be
beneficial.
Any repetitive activity that may exacerbate the
patient's symptoms should be avoided.
For patients who do not respond to these
treatment modalities, the injection technique
may be a reasonable next step.
12.
13.
14. Complications
• rupture
• of th tendons, either from repetitive
• trauma or from injection directly into the
tendon.
• infection.
