Tennis elbow

Lateral epicondylitis

1. Lateral epicondylitis Dr. Ponnilavan Ortho Resident Pondicherry

2. Intro: Not an inflammatory condition Tendinosis that affects the common attachment of tendons of extensor muscles of forearm( esp. ECRB) 1 ST described by F.Runga in 1873 Nirschl described angiofibroblastic tendinosis

3. Etiology Any activity that involves overuse of wrist extensors or supinator muscles Popularly associated while playing tennis Goldie attributed the onset of symptoms to overexertion of the extremity with repetitive wrist extension & alternating forearm pronation or supination. Smidt & van der Windt identified factors that can be avoided to relieve symptoms.

4. Associations Nirschl described mesenchymal syndrome suggesting a genetic linkage to the development of the disease. Tennis elbow pts tend to have higher incidence of RF & HLA-27 +ve Not proved etiopath – Synovial fringe inflammation ( Trethwan) - ECRB tear ( Cyriax) - Radial nerve neuritis ( Kaplan) - Radial nerve entrapment ( Roles & Maudsley) - Radial head fibrillation ( Newman & Goodfellow) - Anconeus inflammation ( Coe et al)

5. Pathogenesis Micro tears-  Angiofibroblastic hyperplasia & disorganised collagen Under- use or stress shielding Compromised blood supply Thermal injury Apoptosis Genetic

6. Clinical features Gripping movements at wrist – painful Point tenderness just anterior & distal to lateral epicondyle & proximal region of ECRB Cozen‘s or Thompson’s test – Resisted wrist extension + radial deviation + full pronation- pain at anterolateral elbow Mill ‘s test – wrist flexion + forearm pronation + elbow extension- pain Maudsley test – Resisted 3 rd digit extension Chair lift test – lift chair with thumb, index & middle finger + elbow extension

7. D/D Cervical nerve root compression Radiocapitellar overload syndrome Osteoarthritis of radial head or capitalism OCD of capitalism PIN Syndrome

8. Investigation Xrays Doppler usg Thermography MRI Nerve conduction study & EMG

9. Rx Non operative- - Rest - NSAIDS Physical therapy Counterforce brace Steroid injection Extracorporeal shock wave therapy Autologous blood injection PRP Acupuncture

10. Surgical Partial resection of annular ligament of Bosworth Distal lengthening of ECRB of Garden Arthroscopic Mx – 1 st described by Grifka, Boenke & Kramer in 1995 Percutaneous release – extensor slide or Hohmann’s epicondylar stripping procedure Rx failures was divided into 2 types by Morrey.

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