Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that connect the forearm muscles to the outside of the elbow. It is commonly caused by repetitive stress activities like tennis, other sports, or occupations involving gripping motions. The most common type is lateral tennis elbow, which involves the tendons on the outside of the elbow. Symptoms include pain and tenderness on the lateral side of the elbow that is worsened by activities. Conservative treatments include rest, physiotherapy, bracing, anti-inflammatory drugs, and steroid injections. Surgery is an option for cases that do not improve with conservative care. Prognosis is generally good with initial treatment but relapses are common.

2. TENNIS ELBOW
 TENNIS ELBOW SYNDROME
ENCOMPASSES LATERAL , MEDIALAND
POSTERIOR ELBOW SYMPTOMS.
 COMMONLY ENCOUNTERED IS LATERAL
TENNIS ELBOW-KNOWN AS CLASSICAL
TENNIS ELBOW
 IT ISTHE PAIN ANDTENDERNESSONTHE
LATERAL SIDE OFTHE ELBOW SOMEARE
WELL DEFINED AND SOMEVAGUE,THAT
RESULTS FROM REPETITIVE SRESS

3. OTHER VERIETIES
 MEDIALTENNIS ELBOW (GOLFERS ELBOW)
INFLAMMATION ATTHE ORIGIN OF
FLEXORTENDONSATTHE MEDIAL
EPICONDYLE OFTHE HUMERUS
 POSTERIOR TENNIS ELBOW-AROUNDTHE
MARGINS OF OLECRANON PROCESS

4. LOCATION OF PAIN IN T.ELBOW
 LATERAL EPICONDYLE (75%)
 LATERAL MUSCLE MASS (17%)
 MEDIAL EPICONDYLE (10%)
 POSTERIOR (8%)

5. LATERAL TENNIS ELBOW
 IT ISTHE LESION AFFECTINGTHE
TENDINOUS ORIGIN OF COMMONWRIST
EXTENSORS
 MEN>WOMEN
 BELIEVEDTO BE A DEGENERATIVE
DISORDER

7. CAUSES
 EPICONDYLITIS-DUETO SINGLE OR
MULTIPLETEARS INTHE COMMON
EXTENSOR
ORIGIN,PERIOSTITIS,ANGIOFIBROBLASTIC
PROLIFERATIONOF ECRB etc
 INFLAMMATION OF ADVENTITIOUS
BURSA-BETWEEN COMMON EXTENSOR
ORIGIN AND RADIOHUMERAL JOINT.
 CALCIFIED DEPOSITESWITH INTHE
COMMON EXTENSORTENDON

8. CAUSES
 PAINFUL ANNULAR LIGAMENT-DUETO
HYPERTROPHYOF SYNOVIAL FRINGE
BETWEEN RADIAL HEADAND CAPITULUM
 PAIN OF NUEROLOGICAL ORIGIN-CS
AFFECTION,RADIAL NERVE ENTRAPMENT
etc

9.  ECRB ISTHE MOST COMMON INVOLVED
STRUCTURE IN L.E
 MORE COMMON INTHE DOMINATEDARM

11. SEEN IN
 ALL LEVELS OFTENNIS PLAYERS(UPTO
50% AT SOMETIME IN CAREER).
 IT IS MORE COMMON IN NONTENNIS
PLAYERS(95%).
 SEEN IN OTHER SPORTSALSO (THROWING
SPORTS , SWIMMING)
 OCCUPATIONAL-CARPENTARY , PLUMPING
,TEXTILEWORKERS
 HOUSEWIVES(SQUEEZING CLOTHES)

12. PATHOPHYSIOLOGY AND RELATED
SYMPTOMS
 STAGE I : ACUTE INFLAMMATION BUT NO
ANGIOBLASTIC INVASION(PT C/O PAIN
DURING ACTIVITY)
 STAGE II:C/C INFLAMMATION+SOME
ANGIOBLASTIC INVASION(PAIN BOTH
DURINGACTIVITY AND REST)
 STAGE III:C/C INFLAMMATIONWITH
EXTENSIVE ANGIOBLASTIC INVASION(REST
PAIN,NIGHT PAINS ,PAIN DURING DAILY
ACTIVITIES)

13. CLINICAL TESTS
 LOCALTENDERNESS ONTHE OUTSIDE OFTHE
ELBOWATTHE C.E.OWITH ACHING PAIN INTHE
BACK OF FOREARM
 COZENSTEST:PAINFUL RESTRICTED EXTENSION
OFWRISTWITH ELBOW IN FULL EXTENSION
ELICITS PAIN ATTHE LATERAL ELBOW.
 ELBOW HELD IN EXTENSION,PASSIVEWRIST
FLEXIONAND PRONATION PRODUCES PAIN.
 MAUDSLEYSTEST:RESTRICTED EXTENSION OF
MIDDLE FINGER ELICITS PAIN ATTHE LATERAL
EPICONDYLE DUETO DISEASE INTHE EXTENSOR
DIGITORUM COMMUNIS

14. RADIOGRAPHY
 AP , LATERAL , RADIOCAPITELLARVIEWS
 16% CASES FAINT CALCIFICATION ALONG
L.E

15. TREATMENT
 CONSERVATIVE MANAGEMENT
REST AND PHYSIOTHERAPY (50-75%)
CHANGINGTENNIS STROKES (92%)
STREATCHING EXERCISES (84%)
USE OF SPLINTS (83%)
NSAIDS (85%)
INJECTION OF LOCAL ANAESTHETIC AND
STEROID
 BOTULINUM TOXIN TYPE ATO PARALYZETHE
COMMON EXTENSOR ORIGINTHAT HAS NOT
IMPROVED WITH CONSERVATIVE MEASURES

16.  MILLS MANOEUVRE
10% OF CASES DO NOT RESPONDTO
CONSERVATIVE MANAGEMENT
A FORCEFUL EXTENSION OF A FULLY FLEXED
AND PRONATED FOREARMAFTER INJECTION

17. SURGICAL METHODS
 PERCUTANEOUS RELEASE OF
EPICONDYLAR MUSCLES
 BOSWORTHTECHNIQUEOF EXICION OF
PROXIMAL PORTION OF ANNULAR
LIGAMENT,RELEASE OFTHE ORIGIN OF
EXTENSOR MUSCLES,EXCISIONOFTHE
BURSAAND EXCISION OF SYNOVIAL
FRINGES.

18. NEW TREATMENT MODALITIES
 USE OF EXTRACORPOREAL SHOCKWAVE
THERAPY(ESWT)
CASES OF FAILED CONSERVATIVE
TREATMENT FOR ATLEAST 6 MONTHS
2000 SHOCKWAVESTHREETIMES AT
MONTHLY INTERVALS FOR 6 MONTHS
 ARTHROSCOPIC RELEASE:OF ECRBWITH
FAILED CONSERVATIVETREATMENT FOR 6
MONTHS.MINIMALLY INVASIVE AND HELPS
IN EARLY REHABILITATION.

19. NEW TREATMENT MODALITIES
 AUTOLOGUS BLOOD INJECTIONS:IN
REFRACTORY CASES,INJECTION OF 2 ML OF
AUTOLOGUS BLOODAND 0.5% BUPIVICAINE HAS
BEENTRIED
 COUNTERFORCE BRACING(TENNIS ELBOW OR
FOREARM BAND):THESE FORCES RELEASETHE
FORCES INTHE ECRB REGION
 REHABILITATIVE EXERCICES:WRIST FLEXION ,
EXTENSION,FOREARM SUPINATION AND
PRONATION,WRIST RADIAL AND ULNAR
DEVIATIONS AT 3 SETS OF 10 REPETITIONS
EVERYDAY FOR 3TO 6 MONTHS(KNOWNTO GIVE
GOOD RESULTS)

20. NEW TREATMENT MODALITIES
 USG GUIDED PERCUTANEOUS NEEDLE
THERAPY:USG GUIDED CORTICOSTEROID
INJECTION AND NEEDLE DEBRIDEMENT OFTHE
STRUCTURES AROUND LATERAL EPICONDYLE.
INDICATION:SMALLTEARS,NOT RESPONDINGTO
CONSERVATIVETHERAPY AND IFTOO SMALL FOR
SURGERY
ADVANTAGES :MINIMALLY INVASIVE PROCEDURE
RESTORATION OF FUNCTION IS RAPID
THE OPTION OF SURGERY IS STILL OPEN
IN EXPERT HANDS IT HAS SUCCESS RATE OF 65%

21. PROGNOSIS
 RESPONSETO INITIALTHERAPY IS
COMMON,BUT SOARE RELAPSE(18-
50%)AND /OR PROLONGED,MODERATE
DISCOMFORT(40%)