|Name||Tissue||Type of pathologies|
|Acute and chronic cervical and lumbar pain||Muscle||Idiopathic cervical and low back pain|
|Acute and chronic soft tissue wounds||Skin||Wounds|
|Calcifying tendinitis of the shoulder||Tendons||Tendinopathy|
|Greater trochanteric pain syndrome||Tendons||Tendinopathy|
|Insertional Achilles tendinopathy||Tendons||Tendinopathy|
|Medial tibial stress syndrome||Tendons||Tendinopathy|
|Mid-body Achilles tendinopathy||Tendons||Tendinopathy|
|Osgood-Schlatter disease||Bone||Disturbance of musculoskeletal development|
|Patella tip syndrome||Tendons||Tendinopathy|
|Primary and secondary lymphedema||Skin||Lymphedema|
|Proliferative connective tissue disorders||Connective tissue||Fibrosis|
|Subacromial pain syndrome||Tendons||Tendinopathy|
|Trigger points||Muscle||Myofascial pain syndrome|
Tennis elbow is a tendinopathy of the common extensor origin of the lateral elbow. In former times the condition was usually named “lateral epicondylitis”. However, the pathology is no longer thought to be inflammatory. Nowadays the accurate description wound be “partially reversible but degenerative overuse-underuse tendinopathy”. Because of the complexity of this description, usually the term “tennis elbow” is used.
The main clinical symptoms are pain on resisted movements (particularly resisted third finger extension) and tenderness at the lateral epicondyle, with normal elbow range of motion. Diagnosis is based on the clinical features of the disease. Diagnostic imaging should be considered to rule out other causes of elbow pain or to establish the diagnosis of tennis elbow when in doubt.
As with other tendinopathies the pathology of tennis elbow is complex and not fully understood. Similar to calcifying tendinitis of the shoulder, sudden overload may alter the structure of the tendons at the common extensor origin, leading to a degenerative process. However, calcifications are rare in tennis elbow. Involvement of neurogenic inflammation in tennis elbow has also been suggested.
The population prevalence is approximately 2%, with peak incidence occurring at 40 to 50 years of age. Approximately 40% of all tennis players report problems with their elbow, but only a quarter of them consider the symptoms to be disabling and severe. Notably most patients with tennis elbow do not play tennis. This is due to the fact that many tennis players have a weekly training routine that regularly loads the tendons and keeps them healthy. Rather, the injury usually occurs in people who have been sedentary for years and then overuse a previously underused and atrophied tendon by exercising at the gym, doing gardening, or even just carry heavy luggage. When the injury is caused by playing tennis it is the backhand stroke that leads to excessive loading of the tendons at the common extensor origin.
The initial treatment should be conservative including rest, physiotherapy, and nonsteroidal anti-inflammatory drugs. As in case of chronic Achilles tendinopathy and chronic plantar fasciopathy, eccentric (lengthening only) exercises have become the mainstay of rehabilitation programmes for tennis elbow. An attractive alternative is radial shock wave therapy (RSWT). In most circumstances, cortisone injections should not be used. This is due to the fact that cortisone leads to very good results in the short term (six weeks) but has been demonstrated to be harmful in the longer term (more than three months). Surgery should be considered when conservative treatment fails.
Yang et al., Am J Phys Med Rehabil 2017;96:93-100.
Efficacy of Radial Extracorporeal Shock Wave Therapy on Lateral Epicondylosis, and Changes in the Common Extensor Tendon Stiffness with Pretherapy and Posttherapy in Real-Time Sonoelastography: A Randomized Controlled Study.READ ABSTRACT
Lee SS et al., Ann Rehabil Med 2012;36:681-687
Effectiveness of initial extracorporeal shock wave therapy on the newly diagnosed lateral or medial epicondylitis.READ ABSTRACT
Mehra et al., Surgeon 2003;1:290-292
The use of a mobile lithotripter in the treatment of tennis elbow and plantar fasciitisREAD ABSTRACT
|STANDARD TREATMENT||MYOFASCIAL THERAPY|
|Number of treatment sessions||3 to 5||3 to 5|
|Interval between two sessions||1 week||1 week|
|Air pressure Evo Blue®||1.5 to 3 bar||3 to 4 bar|
|Air pressure Power+||Not recommended||Not recommended|
|Impulses||2000 on the painful spot||2000|
|Frequency||8Hz to 12Hz||12Hz to 20Hz|
|Skin pressure||Light||Light to moderate|
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