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    Shoulder and Elbow - Tennis Elbow/Lateral Epicondylitis

    Overview
    Causes
    Symptoms
    Risk Factors
    Diagnosis
    Treatment
    Prevention
    Where to Seek Treatment
    Return to Shoulder and 
        Elbow Injuries
    Singapore General Hospital
    Contributed by Dept of Orthopaedic Surgery

    Overview

    Tennis elbow is a common condition in adults in their 40s and 50s. Known formally as lateral epicondylitis of the elbow, it is more commonly known as tennis elbow. While most commonly associated with tennis (10% to 50% of regular tennis players experience it during their playing careers), hence its name, it can occur in any sport or work that requires forceful and/or repetitive forearm usage.

    Causes


    Tennis elbow occurs due to a small tear/microtear in the tendon(s) on the outside of the elbow (lateral side) that attach the forearm muscles to the elbow joint (lateral eipcondyle). Repeated tears leads to the development of damage in the tendon known as angiofi broblastic hyperplasia. The microtear and subsequent development of the damaged tissue is due to forceful and repetitive forearm use.


    Symptoms


    Pain and tenderness over the lateral epicondyle (elbow joint), often radiating down the forearm. Pain is worse on resisted wrist and finger extension with the elbow in full extension. Initially, symptoms may be activity related but in chronic cases, the pain and tenderness may become constant.


    Risk Factors


    Age
    You are at higher risk if > 40 years.

    Activity
    Regular tennis of more than 2 hours playing time each session, or a similar activity.

    Technique
    Tennis players with poor stroke technique (hitting the ball with a flexed elbow) and improper grip size.

    Other factors
    Hard court players are more likely to develop a problem compared to those who use other surfaces.


    Diagnosis

    When the pain and tenderness becomes frequent, and recurs despite adequate rest and analgesics, you should seek medical advice.

    Diagnosis of this condition is essentially made on clinical signs and symptoms. X-rays are done more to evaluate the bone surrounding the muscles and to exclude other potential causes of pain. It may also reveal calcification or the development of bone spurs of the lateral epicondylar region in chronic cases.


    Treatment


    Generally, a period of observation with conservative management of at least 6 month’s duration is recommended. Conservative management includes activity modification, correction of playing technique in sports, improved ergonomics in work-related tennis elbow, analgesics, stretching exercises, counterforce bracing and topical injections of steroids.

    Failure of a trial of conservative management may require surgery to treat symptoms. There are various surgical options available, including open release of the affected tendon with excision of the damaged tissue, arthroscopic release, and newer techniques that stimulate improved blood supply to the affected area.


    Prevention


    Make sure that you have adequate warm up exercises and stretching before any strenuous or repetitive activity to the forearm. Also limit continuous duration of play or activity, and use correct technique. The proper sizing of racquets is important.
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