Tennis Elbow, Update

Abstract

Tennis elbow or lateral epicondylitis was first described more than 100 years ago and its etiology and pathophysiology were multi-factorial and remain uncertain. (19) The condition represents pathology at the common extensor origin on the lateral humeral epicondyle. It is one of the most common injuries among professions that include heavy or monotonous manual work. For the most part, a significant increase is found in the dominant arm with the problem starting mostly with the patient in his forties. (4) Excessive use of the wrist is clearly associated with development of tennis elbow. The pathological changes in the area of extensors origin attributed to three theories which are the tendinogenic, the articular and neurogenic therapy. The tendinogenic theory attributed to generation of the origin of the extensor carpi radialis brevis while the articular prescribed the condition as irritation of the orbicular ligament, synovitis, and irritation of the synovial fringe, bursitis, periostitis or chondromalecia of the capitulum or radial head. The neurogenic theory describes the condition as entrapment neuropathy. Repetitive microtraumatic injury at the extensor origin due to intrinsic overload probably leads to a micro tear that heals through fibrosis and granulation tissue production. As this process continues, mucoid degeneration of the tendinous origin results and with continued use, this eventually leads to partial failure of the tendon. A patient with lateral epicondylitis with complain of pain at the lateral side of the elbow that exacerbated by participation in any activity that requires resisted wrist extension. (4) Also the patient complains of radiating pain to the area of the hand extensors as well as restriction of the movement of the elbow.