Although it is typically a selflimiting process, there are many nonsurgical and surgical treatment options available if lateral epicondylitis becomes chronic and continues to cause pain. Although commonly referred to as tennis elbow when it occurs laterally and golfers elbow when it occurs medially, the condition may in fact be caused by a variety of sports and occupational activities. A vast majority of cases of tennis elbow do get better with treatment. Lateral and medial epicondylitis summit orthopedics. Generally, the most helpful approach is to try strategies to. Tennis elbow, also known as lateral epicondylalgia le and often referred to as epicondylitis or tendinopathy clinically,1 has a complex underlying pathophysiology which is not well understood but is characterized by uncomplicated signs of localized pain over the lateral epicondyle which is made worse with resisted wrist extension. The effect of oscillating energy subjects who met the. You may do the strengthening exercises when stretching is nearly painless. Lateral epicondylitis tennis elbow rehabilitation exercises you may do the stretching exercises right away. Jul 09, 2015 arthroscopic treatment for lateral epicondylitis is a safe and efficient therapeutic option when indicated and implemented appropriately in refractory cases of chronic lateral epicondylitis. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. Eswt treatment for chronic lateral epicondylitis study recap. Lateral epicondylitis le, or tennis elbow, affects 1%3% of the general population each year. Lateral epicondylitis tennis elbow beaumont orthopedics.
The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. A number of treatments for lateral epicondylitis of the elbow have. Muscular biomechanics characteristics and equipment are important in preventing the. The usual age of onset for both lateral and medial epicondylitis is between 35 and 50 years, with an equal distribution between males and females for the lateral entity but a male preponderance of 2. Patients describe a history of activities contributing to overuse of the forearm muscles that originate at the elbow. New nonoperative treatment alternatives with promising.
Lateral epicondylitis, or tennis elbow, is a common condition that usually affects patients between 35 and 55 years of age. Lateral epicondylitis the forearm muscles and tendons become damaged from overuse repeating the same motions again and again. Although it was first reported in 1873, by runge, the association with the term tennis elbow was first made in 1883, by major 1,2 today, it is clear that lateral epicondylitis is a degenerative disorder that compromises the extensor tendons originating. In more severe and chronic cases recovery can be a lengthy process and may take up to 6 months.
A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. Arthroscopic treatment for chronic lateral epicondylitis. Oct 31, 2015 the diagnosis of let is essentially based on a clinical examination that aims to provoke pain in the affected tendon by loading. Arthroscopic treatment for lateral epicondylitis is a safe and efficient therapeutic option when indicated and implemented appropriately in refractory cases of chronic lateral epicondylitis. Bend your wrist forward and backward as far as you can. Most minor cases of lateral epicondylitis that have not been present for long can usually recover within a few weeks.
Hand works occupational therapy lateral epicondylitis. Consequently, the treatment approaches for lateral epicondylalgia vary. Lateral epicondylitis, also known as tennis elbow, is characterized by pain on the outside lateral side of the elbow, caused by damage to the tendons that bend the wrist backward from the palm. Explaining lateral and medial epicondylitis, or tennis elbow, and what causes it, with treatment options based on a conservative model of care. This sometimes takes months so it is important that the patient be consistent with the treatment to be successful. The associated risk factors and available treatment options should become familiar to providers in primary care, occupational. Lateral epicondylitis is the most common diagnosis made in patients with elbow lesions.
This abstract has been presented as a poster at the csm2006 in san diego. Learn about the causes and signs, along with the diagnostic and treatment procedures at. Analysis of trials of treatment for lateral epicondylitis as an example. Guidelines of surgerypersistent pain more than 1 year, pain at rest, high activity level, failure of quality rehab program. Treatment is symptomatic and similar to that of lateral epicondylitis. Pubmed, embase and cochrane database were systematically searched for randomized. Numerous databases were systematically searched from earliest records to february 20. Workrelated risk factors for incidence of lateral epicondylitis in a large working population. Still, only ecswt and lllt have been metaanalytically researched. A patients guide to tennis elbow lateral epicondylitis. Smidt et al noted a greater improvement in pain symptoms from lateral epicondylitis at 52 weeks when employing watchful waiting relative to the administration of corticosteroid injections. Patients should avoid any activity that causes pain. You also may need to avoid certain sports and types of work for a time.
This results in the formation of scar tissue with resultant pain. Lateral epicondylitis is a tendonitis also known as tennis elbow although the majority of people. The occupational therapy centennial vision reinforces the importance of informing consumers about the benefit of occupational therapy and continuing to advocate for the unique clientcentered role of occupational therapy. Learn about the causes and signs, along with the diagnostic and treatment procedures at beaumont. Medial epicondylitis merck manuals professional edition. It is more frequent in sports and occupations that require repetitive actions of the hand and wrist, and can. After your recovery, your doctor or physical therapist can instruct you in how these exercises can be continued as a maintenance program for lifelong protection and health of your elbows. Herquelot e, gueguen a, roquelaure y, bodin j, serazin c, ha c, et al. Surgical intervention for medial epicondylitis involves the open debridement and excision of the undersurface of the flexor pronator mass. Lateral epicondylitis is often encountered in primary care. Tennis elbow, also known as lateral epicondylitis, is one of the most common painful conditions of the elbow. This exercise program for epicondylitis should be continued for 6 to 12 weeks, unless otherwise specified by your doctor or physical therapist. Eswt treatment for chronic lateral epicondylitis study recap the protocol that we are now using for cle is a highenergy onesession treatment protocol.
Tennis elbow, or lateral epicondylitis, is a condition in which the forearm muscles become damaged from overuse. In dutch primary care, 21% of the patients with lateral epicondylitis. Talk to your doctor or physical therapist about which exercises will best help you meet your rehabilitation goals. Operative treatment is required in less than 2% cases.
Lateral epicondylitis, also known as tennis elbow, is the most common overuse syndrome. Epperly, md, family medicine residency of idaho, boise, idaho l ateral epicondylitis. The protocol that we are using is from a just recently published article in the american journal. Epicondylitis symptoms, diagnosis and treatment bmj. This technique also allows excellent viewing of the joint space, in order to diagnose and treat associated disorders using a minimally invasive procedure. Conservative treatment resulted in resolution in 71 patients. This leads to pain and tenderness on the outside of the elbow. Continued stress can lead to a viscous cycle of pain and weakness.
Tennis elbow, also known as lateral epicondylalgia le and often referred to as epicondylitis or tendinopathy clinically,1 has a complex underlying pathophysiology which is not well understood but is characterized by uncomplicated signs of localized pain over the lateral epicondyle which is made worse with resisted wrist extension and grip. This helps relieve symptoms and prevent further damage to the tendons. Progressive exercise of the wrist extensor muscles. Typically occurs during the 4th and 5th decades of life. Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population.
The stretching exercises are focused on stretching the wrist. The results of this study show clinical and statistical significant improvement in grip strength, pain intensity, functional activity, and arm use after treatment compared with a placebo group. International journal of physiotherapy and research, int j. Although its diagnosis can be fairly straightforward, its treatment is often difficult. Lateral epicondylitis nonoperative treatment the pain you have on the outside of your elbow is due microtearing of the tendons coming off the epicondyle bone. Early treatment intervention is therefore vital to hasten recovery. The condition is common in athletes and in people with jobs that require vigorous use of the forearm muscles, such as painters. Recent research has shed more light on the complex etiology of this disorder, which is helping to elucidate the best method of treatment. Inflammation and pain occur on and around the outer bony bump of the elbow where the muscles and tendons attach to. Sep 12, 2012 lateral epicondylalgia tennis elbow is a condition that i, and am sure many other physiotherapists out there, treat very commonly. Lateral epicondylitis is a common entity that affects up to 1% to 3% of the population. Lateral epicondylitis, or tennis elbow, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Inflammation and pain occur on and around the outer bony bump of the elbow where the muscles and tendons attach to the bone. The protocol that we are using is from a just recently published article in the american journal of orthopedics written by john furia md.
Interestingly, despite the frequency with which healthcare is sought for this condition. Initially, rest, ice, nonsteroidal antiinflammatory drugs nsaids, and stretching are used, occasionally with a corticosteroid. Strategy for the treatment of lateral epicondylitis of the elbow using. Chief, division of sports medicine associate professor of orthopaedic surgery tel. This usually consists of the following not all techniques may be presented by your doctor at once as every patients treatment plan is individualized. Nonsurgical approaches to treatment of lateral epicondylitis are numerous. G was a 44 year old accountant who presented to the clinic with a 7 week history of right elbow pain radiating into his forearm. Efficacy of physical therapy for the treatment of lateral. Lateral epicondylitis is usually precipitated by repetitive contraction of the wrist extensors and is characterized by aching pain that is worsened with activity early conservative management is the key to symptom resolution, which eventually allows return to vocational and avocational activities without restriction. Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis. Lateral epicondylitis also referred to as tennis elbow, or more accurately as lateral epicondylosis is a wellrecognized cumulative trauma disorder representing a significant burden in terms of employee disability, health care costs, and loss of productivity.
Evidencebased approach to treating lateral epicondylitis using the occupational adaptation model you will receive an email whenever this article is corrected, updated, or cited in the literature. Extensor tenotomyrelease of ecrb with debridement of chronic inflammatory tissues is the treatment of the choice. The physical examination should reproduce pain in the area of the lateral epicondyle in at least 1 of 3 ways. Many surgical techniques have been proposed for patients with refractory symptoms. Summary lateral epicondylitis is a common cause of lateral elbow pain, first described more than 100 years ago. Survey of current practice in the outpatient departments in scotland. Epicondylitis treatment algorithm bmj best practice. You can manage this and all other alerts in my account. Righthanded, he found it increasingly more difficult to do very basic day to day to activities, such as shaving, driving and use a computer. Treatment of lateral epicondylitis ii treatment of lateral epicondylitis jeanette salmon and susan davidson lewisham hospital, sydney of the total number of injuries treated at the lewisham hospital sports medicine clinic sydney, over a period of eighteen months, lateral epicondylitis constitutes approximately 1 4%. Bilateral lateral epicondylitis answers on healthtap. Common interventions in the treatment of lateral epicondylitis include. In adults, lateral epicondylitis occurs mainly in association with athletic activities in younger individuals or with occupational activities in older patients.
Evidencebased approach to treating lateral epicondylitis. So, the aim of this study was to compare the effectiveness of active release technique art and myofascial release technique mfr in the treatment of chronic lateral. It can be done through a small incision or an arthroscope as an outpatient procedure. Physical therapy for the treatment of lateral epicondylitis le often comprises movement therapies, extracorporeal shockwave therapy ecswt, low level laser therapy lllt, low frequency electrical stimulation or pulsed electromagnetic fields. Doctor answers on symptoms, diagnosis, treatment, and more.
Oct 30, 2018 there are numerous treatment options, but no one single treatment is completely effective. People with lateral epicondylitis are tender approximately 1 cm distal and anterior to the lateral epicondyle. Tennis elbow lateral epicondylitis twin boro physical therapy. Aug 25, 2015 physical therapy for the treatment of lateral epicondylitis le often comprises movement therapies, extracorporeal shockwave therapy ecswt, low level laser therapy lllt, low frequency electrical stimulation or pulsed electromagnetic fields.
A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Search terms included lateral epicondylitis, lateral elbow pain, tennis elbow, lateral. Journal of shoulder and elbow surgery, 193, 363367. Tennis elbow advice and exercises oxford university hospitals.
Jan 25, 2017 lateral epicondylitis the forearm muscles and tendons become damaged from overuse repeating the same motions again and again. Lateral epicondylitis tennis elbow is the most frequent type of myotendinosis and can be responsible for substantial pain and loss of function of the affected limb. Youll need to avoid movements that can make your symptoms worse. Therapeutic exercise program for epicondylitis tennis. Oct 30, 2018 a randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Lateral epicondylitis faq 1 what is lateral epicondylitis. The condition has not been well characterized, although it has been frequently studied. It is generally selflimiting, but in some patients it may continue to. Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. Epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the lateral or medial epicondyle. In one study, patients reported significant functional improvement following surgery. Lateral epicondylitis tennis elbow 2 3 albert cree drive, rutland, vt 05701 802. Lateral epicondylitis is a frequent cause of elbow pain and affects 1 to 3% of the adult population every year.
The prevalence ranges from 1% to 3% in the overall population and is highest in the 30 to 55year age group. In addition, in medial epicondylitis, ulnar nerve symptoms occur in 50% of cases. A physiotherapy program that includes exercise, elbow manipulation manual therapy and selfmanipulation. Pain over the lateral epicondyle of the humerus during loading of the wrist extensor muscles is a common musculoskeletal presentation in men and women between 35 and 54 years of age. Lateral epicondylitis painful resisted wrist extension painful resisted supination rotating forearm as if to hold a bowl of soup in your hand palpation tenderness of the lateral epicondyle rehabilitation what you can expect epicondylitis is a common and often lingering pathologic condition. Historically, it has been termed writers cramp, 1 riders sprain, 2 and finally, the more familiar tennis elbow 3. Lateral epicondylitis tennis elbow rehabilitation exercises. Occupational therapy practitioners working in hand therapy have traditionally found it difficult to combine the biomechanical foundations of hand therapy.
1474 291 588 1345 417 777 1004 1114 122 62 963 793 43 160 213 464 1198 93 195 1078 1324 1288 823 1300 1466 47 1287 1112 919 847 604 1146 765 642 1321 516 1247 794