Tennis Elbow
Epidemiology
- 4 & 5th decades
- M=F
- 75% dominant arm
- 50% of regular tennis players
- Especially > 2 hours/ week
Aetiology
- Poor technique
- Poor grip
- Hard court surfaces
- Occupational
- Plumbers
- Painters
Pathophysiology
- Starts as microtear in ECRB
- Angiofibrotic dysplasia in tendon
- Invasion by fibroblasts & vascular tissue
- Also descriptions of Annular Ligament Fibrositis
History
- Typical patient
- History of overuse
- Pain lateral elbow esp. opening door, pouring tea etc
Examination
- Tender ECRB
- 5mm distal & anterior to common extensor origin
- Sensation normal
- Resisted ECRB Pain (Mills Test?)
Investigations
XR
- Usually normal
- 25% Calcification in soft tissue
Nerve Conduction Studies
- Normal
- Important if uncertain
Differential Diagnosis
- Radiculopathy
- Supinator Syndrome
- LA block if uncertain
- Radial Head Osteoarthritis
Management
- Education & reassurance
- Nonoperative management successful ~ 75-85%
Non Operative
- Activity modification
- Change Racquet
- Change Stroke
- Simple analgesia
- Physiotherapy stretch & strengthening
- Lateral counterforce brace
- HCLA (steroid injection)
- Relief 55-89%
- Recurrence 18-54%
- Peritendinous, not intratendinous
- Risk infection & rupture
Operative Management
- Indication
- failure of nonoperative management
- Despite > 12/12 good nonoperative measures
- Options
- Open Debridement surgery
- Split extensors longitudinally
- Remove angiofibrotic material
- Intra-articular excision of Synovial Fringe
- Distal ECRB lengthening
- Excision of pathologic tendon origin & reattachment with sutures
- Use for recurrent/ severe
- Most likely to give weak dorsiflexion
- Technique
- Tourniquet
- Incision Common Extensor Origin (CEO) Radial Head
- Split ECRB & scoop out Angiofibrotic material
- Release CEO except LCL
- Inspect Radiocapitellar Joint
- Excise Synovial Fringe
- Reattach CEO
- Open Debridement surgery
Webpage Last Modified:
18 February, 2010