Tennis elbow

Synonyms: Epicondylopathia humeri radialis or ulnaris, Epicondylitis, golfers elbow, throwers elbow.
Definition: painful insertion of the tendons at the lateral or medial epicondyle.

• Symptoms
• Pathology
• Incidence
• Examination
• Treatment
• Other causes of pain at the elbow joint

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 thightens 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, pinting 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

Indication