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Tennis Elbow
The medical name for tennis elbow is lateral humeral epicondylitis (but we'll just call it tennis elbow) and it is a painful condition caused by inflammation, or small tears, of the forearm muscles and tendons on the lateral side (outside) of the elbow. It is the common belief of most experts that tennis elbow is caused by damaging vibrations on the forearm caused by incorrect backhand technique. When performing a backhand shot try to use two hands as this greatly reduces the damaging vibrations that cause tennis elbow. Looking at the forearm muscles and tendons of a tennis elbow sufferer under a powerful microscope one can clearly see the hundreds of small rips caused by the vibrations travelling from the racket up the arm and into the forearm muscles and tendons. These rips do not develop and actually repair themselves when a Lastrap elbow support is used. The support simply removes a large amount of these damaging vibrations.

Symptoms

• Persistent pain at the lateral or medial epicondyle
• First signs often after hard exercises
• Increased pain when making a fist or extending the wrist
• Pain over years, 20% bilateral
• Signs of inflammation may occur at the acute stage
• Tenderness of the muscles near the elbow joint

Pathology

• Overuse of the insertion of the tendon to the bone
• In the acute stage there may be haematoma or small tears of the tendons
• The tears result in scars which decrease elasticity of the tendon
• In the microscope you can see fat cells and scar tissue
• There are adhesions between tendon and surrounding tissue
• Tissue shrinks and results in shortening of muscle and tendon
  

Histology

• Muccopolysaccharids
• Calcium deposits
• Fat cells

Incidence

• 18 - 31% of all tennis players
• 1 out of 2 tennis players at least once a lifetime
• 20% bilateral
• 95% of the patients are not tennis players
• 14,5% industrial workers
• 25,3% wrapping industry

Examination

• X-ray
  • Elbow joint, in most cases normal joint, sometimes calcium deposits or signs of degenerative arthritis.

• Ultrasound
  
  • normal in most cases
  • sometimes calcium deposits
  • thickening of the tendon sheet
  • haematoma
  • bursitis
• MRI
  • change of signal of tendon an muscle
  • injuries of the ligaments
  • injuries of the cartilage
• Therapy
  • Local ointment
  • Injections (e.g. Cortison) Massage
  • Stretching of the wrist muscles
  • Immobilization
  • Ultrasound
  • Shock wave
  • Electrotherapy
  • Laser
  • Acupuncture
  • Bandage
  • Tape
  • Manual therapy
  • Radiation (ca. 4 Gy)
  • Operative procedures

Operative Procedures

• Resection of nerves at the epicondyle (Wilhelm procedure)
• Tendon release at the lateral epicondyle (Hohmann procedure)
• Lengthening of the extensor tendon ( Garden procedure)
  

In addition to the procedures mentioned above, often a decompression of a branch of the radial nerve is performed (N. radialis profundus) when it passes through the supinator muscle. Sometimes fibric tissue in that area tightens the nerve which may also cause elbow pain.

Acupuncture

• local points
• lateral: Di10, 3E10
• medial: Hz3, Dü8, Ks3
• distant points
• Ma36, Gb34
• local treatment
• 4 needles under the skin, pointing to the center of pain
• 1 needle directly into the center of pain

Other causes of pain at the elbow joint

• degenerative arthritis of the cervical spine
  • Nerve compression syndrome (N. radialis, N. ulnaris) e.g. by a supracondylar processus
• bursitis
• degenerative arthritis of the elbow joint
• all kind of tumors