IMP.

IN ORTHOPAEDICS SHORTS BY MPMEP

TENNIS ELBOW( LATERAL EPICONDYLITIS)

It is a common clinical entity characterised by pain &
tenderness at the common origin of the extensor group
of muscles of the forearm. It is an extra-articular con-
dition believed to be caused by strain or incomplete
rupture of the forearm extensor muscles or aponeurotic
fibers at their origin, respectively.
On examination, there is tenderness over the lateral
epicondyle of the humerus. Pain is aggravated by
stretching the extensor muscles, e.g., extension at the
Wrist against resistance with the forearm pronated.
Movements of the elbow are full as it is unaffected.
Treatment
(a) Conservative.
Local injection of hydrocortisonewith local anaesthetic
solution relieves pain inmajority of the cases.
(b) Operative treatment. It is rarely indicated in
resistant cases not responding to conservative treat-
ment. The extensor muscles are stripped from their
origin, i.e. lateral epicondyle, and are allowed to fall
back. An above elbow slab with elbow in 90 flexion is
given for a period of 10 days postoperatively. The
elbow is then mobilised.
Physiotherapy management
Physiotherapy plays an important role in the manage-
ment of"tennis elbow".
(a) Preventive.
(b) Prevention of further damage.
(c) Restoration.
(a) Preventive
Repeated forceful jerky movements to the common
origin of extensor group of muscles, is the main cause
Activities like wringing washed clothes. using a
wrench. tightening a serew and even a vigorous hand-
shake should be avoided. Mechanical professions and
sports involving repetition of these movements are
more prone for getting tennis elbow. Similarly.
repeated supination using heavy rackets or weights should
also be discouraged.
Proper conditioning and specific regime of strengt-
hening exercises to extensor carpi radialis longus and
brevis as well as supinator forms the basis of preven-
tive programme. Generalised strengthening of the
common extensor group and avoiding improper strain
beicause of the wrong attitudes in the game, eg. top
spine back hand, or playing tennis with a small handle
rachet.
(b) Prevention of further damage
It is important to prevent further damage and thereby
develop a chronic tennis elbow.
(i) Adequate care during the acute phase, resting the
elbow joint with proper support.
(ii)Instructing and guiding the patient against repeti
tive stretching or trauma to the affected muscles
by avoiding movements of supination, wrist extension and
radial deviation, and tight grips.
(iii)Avoiding hasty mobilisation. Early active move
ment causes repeated breakdown in the formation
of scar tissue which subsequently prolongs the in-
flammatory reaction and leads to the formation of
adhesions.

(c) Restoration:For the restorative programme to be

effective, it is absolutely essential for the physiotherapist to
carefully evaluate the exact nature of involvement
I) Strain and tear of muscle. Tenderness will bepresent at
the musculotendinous juncuon of the extensor carpi
radialis brevis.
(1) Epicondylitis. Partial tear of the tendon at the
origin; with lesion in the subtendinous space
Tenderness is felt exactly over the lateral epicon
dyle. Granulation tissue fomation as well as ad
hesions may be present.
(i) Bursitis. Develops a bursa in the subiendinous
(iv) Articular involvement. Painful joint movemen
Treatment :
1. Croyotherapy. Ice pack for 30 minutes or ice mas
sage for 7 minutes over the painful area or entire
muscle belly.
2 Supportive measures. Initially rest with a splint
holding wrist in mild degree of extension and
sling with elbow in flexion and forearm in supina-
tion. Posterior slab can also be given for the firs
2-3 weeks.
Unfortunately this is usually not done and the
am is allowed free movements which delays the
recovery.
3. Electrical stimulation. Sinusoidal stimulation forspasm.
prevents formation of adhesions andreduces oedema.
20 minutes with arm in elevation relieves muscle spasms.

4.lontophoresis. It can help in reducing pain and in-

flammation.

5. Diapulse, ultrasonics. TENS can be effecive in

controlling pain and inflammation. Ultrasoundwith
hydrocortisone cream of 0.05 percent concentration as a
coupling agent has been reportedas a useful modality.

6. Gentle effleurage and kneading during the first 2 weeks

& friction massage after 2-3 weeks is adopted.

7. Gentle active movements of elbow, wrist and

hand and isometrics at the end of each raase. if It
is not painful. should be carried out hdm
phasis on the wrist extensors.

8. Mild resistive exercises. Self-controlled nsve

exercises by using good arm to resistive
ments of wrist extension, radial deviation
flexion and forearm supination to be initiated
Trial of resistive exercises (Isometrics)could be given.
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............................. by
meenakshiputraeashwarprasad.19@gmail.com