Before starting on this section, it is vital that you can answer the following questions:

  1. Where are the medial and lateral epicondyles of the elbow found?
  2. What do tendons attach together, and what are the two tendons in the elbow joint?
  3. Which parts of the humerus do the extensor and flexor muscles of the forearm attach to?

Not quite sure what the answers are? Do not worry, click on the button below!

After completing the “Tennis Elbow” section, you will be able:

  • To apply knowledge of the elbow joint to explain the pathophysiology
  • To explain the clinical presentation and immediate management
  • To describe the diagnosis
  • To discuss the management
  • To validate knowledge by completing the quiz

 

Tennis elbow = Lateral epicondylitis

Sport Risk Factors

 Racquet sports such as tennis. * TIP: Tennis elbow = tennis! *

Vinette

Roger Federer, winner of 18 Grand Slams in tennis, has developed pain and inflammation on the lateral aspect of his elbow which has been getting progressively worse over the last few months since the start of the tennis season. 

Pathophysiology

  • Extensor muscles of the forearm originate from the lateral epicondyle

1. Repetitive/overuse strain of the extensor muscles of the forearm

2. This causes tears in the common extensor tendon

3. This causes pain and inflammation of the tendon around its origin, the lateral epicondyle of the humerus.

Clinical Presentation

  • Pain and inflammation is felt at the lateral epicondyle of the humerus
    • Exacerbates (worsens) during wrist/forearm extension.

 * TIP: ANALOGY: As holding a heavy bag (WRIST EXTENSOR) causes pain. Imagine Roger Federer is in pain when holding his heavy tennis bag. *

Immediate Management

  • Rest from actions causing or exacerbating pain

 

Diagnosis

  • Clinical diagnosis and examination
    • Active wrist extension against resistance whilst pressing down on the lateral epicondyle, triggers the characteristic pain felt by a patient with tennis elbow

Management

* Management follows the progression from conservativemedical surgical. *

 1. REST + REVIEW (conservative)

  • REST – Resolves through restriction of activities which overload the tendons. (cases last 6-24 months) (90% recover within 1 year)
  • REVIEW – Refer/review to physiotherapy for further management – most effective non-surgical treatment.

 2. SHORT-TERM RELIEF (medical)

  • Analgesia or corticosteroid injection provides short-term relief

 3. SURGERY (surgical)

  • Surgical tendon release is the surgery of choice.
  • Only indicated in severe cases that are unresponsive to conservative and medical management

Click here for the NICE Guidance.

  • Tennis conservative
    1. Rest + Review (conservative)
  • Tennis medical
    2. Short-term relief (medical)
  • tennis surgery
    3. Surgery (surgical)

References

Baldwin A, Hjelde N, Goumalatsou C, Myers G. (2016). Oxford Handbook of Clinical Specialities. 10th ed. Oxford: Oxford University Press.

Geeky Medics. (2017). Elbow examination – OSCE Guide. Available at: https://geekymedics.com/elbow-examination/ [accessed 1 March 2017].

Kumar P, & Clark M. (2016). Kumar & Clark’s Clinical Medicine. 9th Ed. Edinburgh: Elsevier.

National Institute for Health and Care Excellence: Clinical Knowledge Summaries. (2015). Tennis Elbow[online]. Available at: https://cks.nice.org.uk/tennis-elbow#!topicsummary [accessed 1 March 2017].

 

Image References

Roger Federer.   Pathophysiology.   Clinical Presentation.   Immediate Management.   Diagnosis.   Management 1, 2 + 3.