TENNIS ELBOW

TENNIS ELBOW

1. TENNIS ELBOW BY Dr Atanu Kayal First year PGT(BMCH)

2. What is tennis elbow??? Tennis elbow is a common term for a condition caused by over use of arm, forearm, and hand muscles that results in elbow pain. Also known as lateral epicondylitis...... originally described by Major in 1883 as lateral elbow pain in tennis players.

3. INTRODUCTION Lateral epicondylitis describes an over use injury secondary to overload of the common extensor tendon at the origin of extensor carpi radialis brevis (ECRB) tendon.

4. ETIOLOGY Overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and /or wrist extension. It historically occurs in tennis players but can results from any sports that require repetitive wrist extension, radial deviation and/or forearm supination.

5. PATHOPHYSIOLOGY AND HISTOPATHOLOGY This condition is primarily a degenerative overuse process of ECRB and common extensor tendon. Histological findings include granulation tissue, micro rupture, abundance of fibroblasts, vascular hyperplasia and unstructured collagen and lack of inflammatory cells. So epicondylitis is misnomer. HPE showing angio fibroblastic hyperplasia and hyaline degeneration

6. EVALUATION

7. DIFFERENTIAL DIAGNOSIS

8. STAGES OF TENNIS ELBOW

9. CLINICAL TESTS COZENS TEST: painful restricted extension of wrist with elbow in full extension elicits pain at lateral elbow MAUDSLEYS TEST: resisted extension of middle finger elicits pain at lateral condyle due to disease in the extensor digitorum  communis.

10. RADIOGRAPH FOR TENNIS ELBOW The AP, LATERAL, and RADIOCAPITELLAR views are recommended views. Most cases it is normal but 16% cases a faint calcification along the lateral epicondyle can be detected.

11. TREATMENT CONSERVATIVE MANAGEMENT Physiotherapy exercise Wrist extension stretch and flexion stretch Wrist extension strengthening and flexion strengthening Injections of local anesthetic and steroids.

12. SURGICAL MANAGEMENT INDICATIONS: Severe pain for 6 weeks... Marked and localized tenderness Over lateral epicondyle. Failure to conservative management. Percutaneous release of epi condylar muscles. BOSWARTH techniques...excision of proximal portion of annular ligament, release of origin of the extensor muscles excision of bursa  and excision of synovial fringes.

13. Recent advance

14. THANK YOU