Tennis elbow can be caused by playing tennis or any other physical activity which places repeated stress on the elbow joint and consequently a person develops a repetitive strain injury. Tennis elbow is a condition that causes pain around the outside of the elbow (pain that occurs on the inner side of the elbow is often known as golfer's elbow).
Tennis elbow is clinically referred to as lateral epicondylitis; it is a common and well defined clinical entity. It is an extra-articular affection characterised by pain and acute tenderness at the origin of the extensor muscles of the forearm. Cause: it is believed to be caused by strain of the forearm extensor muscles at the point of their origin from the bone.
· on the outside of the upper forearm, just below the bend of the elbow
· when lifting or bending the arm
· when gripping small objects, such as a pen
· when twisting the forearm, such as turning a door handle or opening a tin.
Clinical Features – there is pain at the lateral aspect of the elbow, often radiating down the back of the forearm. On examination there is tenderness precisely localised to the front of the lateral epicondyle of the humerus. Pain is aggravated by putting the extensor muscles on the stretch, for example, by flexing the wrist and fingers with the forearm pronated.
If left alone the symptoms eventually subside spontaneously but they could however persist for two years or longer. Conservative treatment should be by an injection of hydrocortisone, with local anaesthetic, into the point of greatest tenderness. This method is often successful but only if the injection is made into the precise spot – in a successful case the pain is often exacerbated for twenty-four hours or so before it begins to gradually disappear.
If local injections fail, a course of physiotherapy is usually recommended, in the form of short-wave diathermy, deep massage to the tender area, and faradic stimulation of the extensor muscles. Operative treatment – if severe disability fails to respond to conservative treatment, operation is well worth while. The extensor origin is stripped from its attachment to the lateral epicondyle and allowed to fall back into place.
Disorders of the Elbow (Deformities): Cubitus Valgus and Cubitus Varus (Manual Workers)
Cubitus valgus is usually a consequence of previous disease or injury in the elbow region. The most frequent causes are: (1) previous fracture of the lower end of the humerus or the capitulum, with mal-union; and (2) interference with epiphysial growth on the lateral side, from injury or infection. The most important sequel of cubitus valgus is interference with the function of the ulnar nerve; may lead to osteoarthritis of the elbow, especially for those who do heavy manual work.
Osteoarthritis – of the elbow seldom occurs in an elbow that was previously normal. In nearly every case a predisposing factor has been present for several years. This is usually a damaged articular surface from previous fracture involving the joint, or from osteochondritis dissecans.
Osteochondritis Dissecans of the Elbow
After the knee, the elbow is the most frequent site of osteochondritis dissecans. The disorder is characterised by necrosis of part of the articular cartilage and the underlying bone, with eventual separation of the fragment to form an intra-articular loose body. Cause – injury, impairment of blood supply to the affected segment of bone.