TENNIS

ELBOW
ABHAY JAIN
126
INTRODUCTION
• Pain and tenderness at the lateral
epicondyle of the humerus due to non-
specific inflammation at the origin of
the extensor muscles of the forearm

• Tendinosis that affects the common

attachment of tendons of extensor
muscles of forearm(esp. ECRB)

• Also known as lateral epicondylitis (but

not an inflammatory condition)
ETIOLOGY
• Popularly associated while
playing tennis
• But more common in non tennis
players (95%)
• Any activity that involves
overuse of wrist extensors or
supinator muscles
• repeating the same motion over
and over again
• Carrying heavy loads
PATHOPHYSIOLOGY
• Stage 1 : acute inflammation but no angioblastic invasion (patient c/o
pain during activity)

• Stage 2 : c/c inflammation + some angioblastic invasion (pain both

during activity and rest)

• Stage 3 : c/c inflammation with extensive angioblastic invasion (rest

pain, night pains, pain during daily activities)
CLINICAL FEATURES
• Tenderness, precisely localised to the
lateral epicondyle of the humerus
• Pain is aggravated by putting the
extensor tendons to a stretch
• Painful and weak grip
• Cozen’s or thompson’s test - wrist
extension, radial deviation and full
pronation against resistance - pain at
anterolateral elbow
• Maudsley’s test - restricted
extension of middle finger
elicits pain at the lateral
epicondyle due to disease in
the extensor digitorum
communis

• Mill‘s test - wrist flexion +

forearm pronation + elbow
extension - pain

• Chair lift test - lift chair with

thumb, index & middle finger
+ elbow extension - pain
TREATMENT
• Rest your arm and avoid the activity that causes
your symptoms for at least 2 - 3 weeks
• Put ice on the outside of your elbow 2 - 3 times a
day
• The patient is initially treated with analgesics–anti
inflammatory drugs for a week or so
• If there is no response, a local injection of
hydrocortisone at the point of maximum tenderness
generally brings relief
• Compression strap applied distal to bulk of extensor
mass(to reduce maximum contraction). It is used
only during aggravating activity.
GOLFER’S
ELBOW
INTRODUCTION
• Inflammation is at the origin of the
flexor tendons at the medial
epicondyle of the humerus

• Also known as medial epicondylitis

• Pain on inside of the elbow

CAUSES
• overusing the muscles in the forearm
that allow you to grip, rotate your arm
and flex your wrist
• Repetitive flexing , gripping or swinging
can cause pulls or tiny tears in the
tendons
• Racket sports (small, heavy or tight)
and throwing sports (improper pitching
techniques)
• Occupations requiring strong hand grip
and adduction of elbow
CLINICAL FEATURES
• Tenderness under medial epicondyle
• Pain when shaking hands
• Weak grasping
• Numbness and tingling from your
elbow up and into your pinky and
ring fingers
• Pain when flexing your wrist
TREATMENT
• Restrict activities and movement of the elbow and
take adequate rest to gradually diminish the pain.
• Ice Pack: Application of ice wraps for 15 to 20 minutes
at a time, three to four times a day for several days.
• The patient is initially treated with analgesics–anti
inflammatory drugs for a week or so
• If there is no response, a local injection of
hydrocortisone at the point of maximum tenderness
generally brings relief
• Brace (compression strap): Putting a brace on the
elbows hinders free movement and reduces tendon
and muscle strain.
THANK
YOU