this is basic presentation, it covers all aspects of this condition

1. BY: Dr. SURESHKUMAR
(HO)
ORTHOPEDIC DEPT.
LYARI GENERAL HOSPITAL

2. • Lateral epicondylitis, or “tennis elbow,” is
a common musculotendinous
degenerative disorder of the extensor
origin at the lateral humeral epicondyle.
• Repetitive occupational or athletic
activities involving wrist extension and
supination are thought to be causative.
• The typical symptoms include lateral
elbow pain and tenderness, pain with
wrist extension, and weakened grip
strength.

3. .Lateral epicondylitis in the general population
has been reported to range from 1% to 3% in
adults.
.Men and women being affected equally.
.It most prevalent in the fifth decade of life,
with peak incidence occurring between the
ages of 45 to 54 years.
.Those with manually intensive occupations or
those who use vibratory tools may have an
increased risk.

4. . The lateral elbow is composed of
bony and ligamentous structures
and serve as an origin for Yhe
musculotendinous attachments of
the dorsal forearm.
.The common extensor origin
consists of 5 muscles.
. Most common involved muscle in
tennis elbow is extensor carpi
radialis brevis.

5. • Tennis elbow is often due to damage to a
specific forearm muscle.
• The extensor carpi radialis
brevis (ECRB) muscle helps the
wrist when the elbow is straight.
• When the ECRB is weakened from overuse,
microscopic tears form in the tendon where
it attaches to the lateral epicondyle. This
leads to inflammation and pain.
• As the elbow bends and straightens, the
muscle rubs against bonybumps. This can
cause gradual wear and tear of the muscle
over time.

6. . Typicaly presentation of tennis elbow is
pain and tenderness that starts at the lateral
epicondyle of the elbow.
. The pain is typically of gradual onset and
may spread down the forearm. It may go as
far as the back of the middle and ring fingers.
. Tennis Elbow Usually affects one arm, but in
10-20% of cases affects both arms.
. Sometimes the elbow feels stiff and won't
straighten out completely.

7. • Usually diagnosed on clinical basis ( includes history and physical
examination) but imaging is important to exclude other conditions of
elbow joint.
• Pain provoking tests:palpates the patient's lateral epicondyle with one
hand, while pronating the patient's forearm, fully flexing the wrist, the
elbow extended. A reproduction of pain in the area of the insertion at the
lateral epicondyle indicates a positive MILL’S test. while pain on resist
wrist extension, positive COZEN’S test .
• X-rays: can confirm and distinguish possibilities of existing causes of pain
that are unrelated to tennis elbow, such as fracture or arthritis. Rarely,
calcification can be found where the extensor muscles attach to the lateral
epicondyle.
• Ultrasonography and magnetic resonance imaging (MRI): are other
valuable tools for diagnosis but are frequently avoided due to the high
cost.

8. General activities
which make the pain worse should be avoided
or at least cut back.
is very helpful for this
condition to limit pain and to decrease
inflammation. It is recommended that the area
be iced 2 to 3 times a day, especially after any
activity, for 20 to 30 minutes.
t is
one of the mainstays of treatment for this
condition. A gentle stretching program is
started through a range of motion at the elbow
and wrist. This is combined with a program of
muscle strengthening.

9. There are several different models available and they are designed to
be worn 2-3 centimeters from the elbow. This is intended to take the stress off
the tendon where it attaches to the bone. The strap is to be worn during sports
and during work
Oral nonsteroidal anti-inflammatory drugs are very helpful in
controlling the pain and inflammation of tennis elbow.medicine be taken daily
for at least four to six weeks when treating severe cases. For less severe cases
these medicines may be taken only when needed.

10. These are considered when the above
measures have not worked and the pain is severe. The
cortisone is injected into the area of the inflamed
tendons in order to decrease the inflammation.
if symptoms do not respond after 6 to 12
months of nonsurgical treatments, surgery may
recommend . Most surgical procedures for tennis elbow
involve removing diseased muscle and reattaching
healthy muscle back to bone.
The most common approach to tennis
elbow repair is open surgery.
Tennis elbow can also be
repaired using tiny instruments and small incisions. Like
opensurgery, this is a same- day or outpatient
procedure.