|
|
|
A Pain Doctor’s Guide To Tennis Elbow Summertime is here and pain clinic waiting rooms are filling up with weekend warriors with myriad pain complaints from over doing it. Among the most common of these is tennis elbow. Tennis elbow (also known as lateral epicondylitis) is caused by repetitive microtrauma to the extensor tendons of the forearm. Coexistent bursitis, arthritis, and gout also may perpetuate the pain and disability of tennis elbow. Tennis elbow occurs in patients engaged in repetitive activities that include hand grasping, such as politicians shaking hands or high-torque wrist turning such as scooping ice cream at an ice cream parlor. Tennis players develop tennis elbow by two separate mechanisms: first, increased pressure grip strain as a result of playing with too heavy a racquet; and second, making backhand shots with a leading shoulder and elbow rather than keeping the shoulder and elbow parallel to the net. Other racquet sport players also are susceptible to the development of tennis elbow. The pain of tennis elbow is localized to the region of the lateral epicondyle. It is constant and is made worse with active contraction of the wrist. Patients note the inability to hold a coffee cup or hammer. Sleep disturbance is common. On physical examination, there is tenderness along the extensor tendons at or just below the lateral epicondyle. Many patients with tennis elbow exhibit a bandlike thickening within the affected extensor tendons. Elbow range of motion is normal. Grip strength on the affected side is diminished. Patients with tennis elbow demonstrate a positive tennis elbow test. The test is performed by stabilizing the patient's forearm and then having the patient clench his or her fist and actively extend the wrist. The examiner then attempts to force the wrist into flexion . Sudden, severe pain is highly suggestive of tennis elbow.
If a patient’s tennis elbow doesn’t get better, the pain clinician should consider other diagnosis as radial tunnel syndrome and occasionally C6-C7 radiculopathy can mimic tennis elbow. Radial tunnel syndrome is an entrapment neuropathy that is the result of entrapment of the radial nerve below the elbow. Radial tunnel syndrome can be distinguished from tennis elbow in that with radial tunnel syndrome, the maximal tenderness to palpation is distal to the lateral epicondyle over the radial nerve, whereas with tennis elbow, the maximal tenderness to palpation is over the lateral epicondyle. If in doubt, obtain an EMG which will help distinguish cervical radiculopathy and radial tunnel syndrome from tennis elbow. |
