TENNIS ELBOW
OR LATERAL EPICONDYLITIS

Lateral epicondylitis is a painful condition at the outer forearm, just where forearm meets the arm. This condition is also known as tennis elbow. Lately due to new evidence this condition has been brought under the umbrella of OOS (Occupational Overuse Syndromes also known as repetitive strain injury (RSI) syndromes.

TENNIS ELBOW SYMPTOMS

Tennis elbow pain is most often connected to the activity of the arm or a wrist such as opening a jar or a door. Pain could also be quite intense with burning quality.

ETIOLOGY
(Cause)

Latest studies have revealed a widespread mechanical hypersensitivity in patients suffering with lateral epicondylitis. Studies show that the brains perception of mechanical input such as occurs with normal activities of daily living is heightened. Patients with tennis elbow have significantly higher pain levels to pressure or cold applied over the muscles of the forearm. This evidence supports a role of peripheral sensitization mechanisms in the initiation of this syndrome.

In patients younger then 45 years old the cause is repetitive strain (overuse)
Sensitization phenomenon (also occurring in younger population)
In patients older then 50 years old with presence of degenerative joint disease in the cervical spine (neck arthritis) the cause is secondary to the degenerative disease disrupting neck arm nerve connection.

TYPES OF LATERAL EPICONDYLITIS

There are three types of lateral epicondylitis:

Osteogenic – the pain is in the bony prominence of the lateral epicondyle
Myofascial – the muscles attaching to the lateral epicondyle are either hypotonic (weak and flaccid) or hypertonic (too tense)
Tendinosis – there is a degenerative process occurring in common extensor tendon (the tendons originating in the lateral epicondyle which primary function is to extend the wrist)
Arthrogenic – facilitated hyperactivity of elbow musculature secondary to secondary to the degenerative disease of the cervical spine

Diagnosis is clinical.
Could be confirmed
by diagnostic ultrasonography.

DIFFERENTIAL DIAGNOSIS

Following conditions could mimic tennis elbow:

Radial nerve impingement
Posterior interosseous nerve impingement
Elbow arthritis
Fracture of lateral epicondyle (trauma must be present)
Cervical radiculopathy

CASE STUDY

A forty-eight-year-old female writer presents with pain in the lateral elbow. She has been diagnosed with Lateral Epicondylitis (tennis elbow) and given steroid injection. She had no resolution of her symptoms and then went to see another doctor who treated her with extracorporeal shockwave and five months of physical therapy. Nine months into the problem she was still in pain.

We did diagnostic ultrasonography and did not see any tendinosis of tendons inserting over the lateral epicondyle, however we did find a compression of the Posterior Interosseous Nerve (PIN) at the entrance of the Arcade of Froshe. The PIN nerve compression is a common mimicker of a tennis elbow. This compression in the mild or even moderate form can easily be missed on MRI. Diagnostic ultrasonography is 100% diagnostic and early diagnosis is an edge between conservative care and surgical decompression of the tunnel.

RISK FACTORS

Postural support of the spine, shoulder and neck plays a key role in distribution of forces throughout elbow and forearm. In other words, inadequate support of the neck and shoulder blades on the spine causes further peripheral imbalance into muscles traveling across multiple joints of shoulder, elbow and wrist. Scientific evidence and clinical experience shows us that recovery time of treatment for wrist and elbow syndromes are much abbreviated when stability of shoulder blades is addressed.

Wrist mobility. Wrist and finger mobility is one of the most important factors in formation of stress to the lateral elbow.

Tissue texture quality plays an important role in development of musculoskeletal conditions of upper extremities. Women are usually more affected with painful syndromes of wrist and elbow due to different hormonal profile, which negatively affects tissue tensile quality.

TENNIS ELBOW TREATMENT

Deficit in grip strength is a primary physical impairment in patients with tennis elbow. This deficit is predominately due to prior weakness and disruption of coordination to shoulder-elbow -wrist connection. Therefore pain is a result of consequences of this disruption to motor function. Therefore the mainstay of successful treatment of this condition is specific therapeutic exercise. There is significant evidence to support the role of isometric exercise in reducing pain, particularly in a ‘non-compressed’ position. There is also significant evidence (up to 76%) for treatment of chronic lateral elbow pain with Extracorporeal Shock Wave therapy.

Treatment for Elbow Pain at NYDNRehab

For patients suffering from tennis elbow pain, we provide the most comprehensive approach. We use Dynamic Neuromuscular Stabilization (DNS), to restore alignment, mobility and stability at the elbow, wrist and shoulder. Our specialists also use many different types of fascial manipulation to improve motion control, allowing the myofascial tissue to lengthen and reduce stress to the muscles and tendons and their insertion to the bone at the lateral epicondyle. We also use acupuncture to eliminate active trigger points in the area of the forearm.

For patients suffering chronic severe pain or who have not responded well to conventional treatments, we may perform extracorporeal shockwave therapy (ESWT). Because shockwave therapy does not require a subcutaneous incision, it is non-invasive regenerative therapy. Low-intensity set of pressure and acoustic waves are used to stimulate metabolism and enhance the blood circulation in the affected area (neovasculogenesis). ESWT is a biological regenerative treatment that accelerates the healing process, gradually regenerating and restoring damaged tissue. Those hoping to treat elbow pain need look no further than the NYDNRehab.

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