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Tennis Elbow

Tennis Elbow

Tennis elbow or Lateral Epicondylagia, is a common chronic musculoskeletal condition with approximately 40% of the population experiencing it at some point in their lives.

It is most common in men and women aged between 35 and 54 years.

The condition affects the elbow and forearm and causes significant pain, disability and loss of function.

Symptoms may persist for years and recurrence is common.

Typical signs and symptoms include pain and tenderness over the outer elbow or Lateral Epicondyle, exacerbated by resisted wrist extension and passive wrist flexion. Grip strength may be reduced also.

Most cases are associated with work related activities and have no obvious trauma.

The name implies to a process of inflammation, however, recent evidence has shown that it is not an inflammatory condition.

Recent studies have demonstrated that the affected tendon, usually the Extensor Carpi Radialis Brevis (ECRB), has a dense population of fibroblasts, disorganised and immature collagen, and an absence of inflammatory cells. These findings are considered characteristic of a degenerative process called Angiofibroblastic Hyperplasia , now commonly known as tendinosis.

The cause of pain in the absence of an inflammatory mechanism to the tendon, is therefore, under discussion. It has been hypothesised that certain by products of increased cellular activity or tendon degeneration, such as lactic acid and chondroitin sulphate,  irritate the sheaf surrounding the tendon which in turn causes a local release of substances, which cause nerve inflammation.

Lateral Epicondylalgia is a complex condition and it may be years before all questions are answered. However, we cannot ignore the current literature, which provides consistent evidence that there is an absence of an inflammatory component. This would indicate that the current term, Epicondylitis, is inaccurate and misleading.  

In addition to the ECRB tendon, many anatomical structures have been identified as possible sources of Lateral Epicondylar pain.

Due to the complex nature of this condition, it reinforces the need to conduct thorough clinical assessments on each and every patient to identify, as best as possible, the contributing source(s) of pain in order to provide optimal management strategies.

Treatment: Physiotherapy treatment encompassing mobilisations to the neck and upper back along with soft tissue work to this area,  as well as the elbow and forearm will be of benefit. Strength work for the shoulder girlde, posture and work aggravating factors will also be addressed. 

Exercises for the arm performed on a daily basis have been shown to be of benefit and effective at reducing pain and improving function. There are a variety of exercises that can be implemented to enable self management of your symptoms and cure.

6th October, 2018

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