Lateral Epicondylitis Tennis Elbow

¶ … Epicondylitis: A Review of the Literature

Mechanism of Injury/Force Involved

Lateral epicondylitis or "tennis elbow" as is commonly referred to often results from pathological processes that occur within the elbow (Foley 281). This injury is most commonly the result of occupational stresses and not necessarily the result of racket sports, though the force involved in such sports may contribute to injury (Foley 282). Direct force is not necessary for the condition to arise and most cases result from repetitive motion or overuse rather than significant impact at one time or another (Foley 292). Given this knowledge one may assume that preventive measures can be implemented to reduce the frequency of the disease.

Lateral epicondylitis occurs as the "muscle bellies" of the forearm narrow and "merge into the tendons" creating "highly focused stress" at the point where the tendons and bones insert into the bone of the elbow (Nicholas 1). Injury to the outer region or lateral portion of the elbow is considered one of the most common injuries in the sport of tennis; the name 'tennis elbow' hence arises and is commonly the result of "overuse of the extensor tendons of the forearm, particularly the extensor carpi radialis brevis" (Nicholas 1). The injury more commonly occurs in novice or amateur players resulting from a combination of factors that may include poor technique, late wing preparation that results in wrist snap or hitting the ball with full force when serving and pronating the wrists, which results in "wrist snap which increases the stress on the already taught extensor tendons" (Nicholas 1).

Another form of epicondylitis can occur referred to as "medial epicondylitis" which results when a player snaps the wrist sharply during the course of play or when a tremendous amount of force is placed on the medial tissues surrounding the elbow typically during the serve portion of play (Nicholas 1). Improper techniques can also contribute such as improper backstroke.

Any activity that results in repetitive motion and stress or strain on the elbow epicondylitis can result in pain or injury; most commonly affected include those engaging in tennis, golf, swimming, typing, construction work, hand shaking and any other activity that requires frequent or repetitive motion (Nicholas 1).

Typically pain results when the wrist "is extended against resistance or during repetitive actions with the wrist and elbow extended" (Foley 282). Causes may include a lesion at the wrist extensor mechanism or near the "lateral epicondyle of the humerus" (Foley 282). Studies utilizing U.S. diagnosis suggest that a relationship exists between lateral epicondylitis and "intratendinous calcification, tendon thickening, adjacent bone irregularity, focal hypoechoic regions and diffuse heterogeneity" (Levin, et. al 230).

Legal Concerns How To Prevent When Dealing With Injury in Canada

In Canada and other countries legal concerns include appropriate diagnosis of lateral epicondylitis and assessment of whether the injury has resulted from repetitive motion or from an abrupt injury unrelated to a job role or work function (Crossman, et. al 100). Patient education and a patient disability inventory may be warranted in many cases to evaluate what treatment modalities are warranted in a given situation (Crossman, et. al 100). In the case of work related injuries prevention is key thus diagnostic tools and preventive steps should be taken to ensure that patients are aware of what motions may exacerbate or contribute to their condition and so that appropriate measures can be taken including establishing an ergonomic work environment to prevent injury when possible (Crossman, et. al 100).

Newer evidence has focused on adopting psychological measures to assist patients suffering from pain associated with lateral epicondylitis and associated respective injury problems. These studies suggest that psychological issues may exist in some patients with certain forms of pain, and hence physicians must have more awareness of a patient's medical state prior to diagnosis (Crossman et. al 100). This presents even new legal challenges as physicians and workforce organizations must ensure the privacy of patients undergoing psychological screening is held confidential and secure. In most cases patient's consent to treatment will have to be obtained in order to fully ascertain the influences on a patients health and well being if diagnosed with lateral epicondylitis or associated disorders.

Assessment & Management Strategies Acute and Chronic Cases

There are a variety of assessment tools that can be used to diagnose lateral epicondylitis and identify what findings are most likely associated with symptoms (Levin, et. al 230). Diagnostic tools may include a variety of interventions including MRI scans and radiography as well as physical examination to determine the extent of injury and strength of the areas affected (Levin, et. al 230). In recent years among the more commonly used diagnostic tools including ultrasound (U.S.) which studies suggest have a high sensitivity rate for detection of but low specificity with regard to detecting symptomatic lateral epicondylitis (Levin, et. al, 230).

Management of lateral epicondylitis will depend on the nature of the injury and severity of the condition once diagnosed. The condition is often chronic hence it is important that proper and prompt treatment is sought as soon as symptoms begin. The longer a patient has experienced symptoms the more likely aggressive interventions will be sought (Nicholas 1). Common rehabilitative and management practices include physical therapy, rest and application of ice to the area to help reduce inflammation (Nicholas 1). This may be accompanied by use of NSAID to reduce pain and inflammation. Therapy is often directed or focused on improving range of motion, endurance and normal functioning of the areas affected (Stasinopoulos & Johnson 425; Nicholas 1; Thornton, et. al 1558).