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Lateral epicondylitis

Lateral epicondylitis is a condition when the outer part of the elbow becomes painful and tender, usually as a result of a specific strain, overuse, or a direct bang. Sometimes no specific cause is found.

What causes Lateral epicondylitis

This injury is caused by repetitively twisting the wrist or forearm. The injury is classically associated with tennis playing, hence the name "Lateral epicondylitis", but any activity that involves repetitive twisting of the wrist (like using a screwdriver) can lead to lateral epicondylitis.

The most common cause is over use of the muscles which are attached to the bone at this part of the elbow. That is to say, the muscles which pull the hand backwards (the wrist extensors). All the extensor muscles of the hand attach to the elbow at the outer part (the lateral epicondyle). If they are strained or over used they become inflamed, which means they are swollen, painful and tender to touch.

Sometimes the inflammation is caused by a direct injury or bang. Sometimes, especially when the cause is direct injury or strain, the muscles are actually partially torn.

Symptoms of Lateral epicondylitis

  • Elbow pain that gradually worsens
  • Pain radiating from the outside of the elbow to the forearm and back of the hand when grasping or twisting
  • Weak grasp

Diagnosis of Lateral epicondylitis

Lateral epicondylitis is characterized by pain and tenderness on the outside part of the elbow. This pain will worsen with any attempt to either play racquet sports or lift heavy objects with the wrist and hand.

Elbow X-rays are done to evaluate the bone surrounding the muscles.

Rarely, an MRI may be ordered to rule out a large tendon tear.

MRIs of normal and partially torn tendons

Treatment of Lateral epicondylitis

Heat or ice is helpful in relieving Lateral epicondylitis pain. Once acute symptoms have subsided, heat treatments are used to increase blood circulation and promote healing. The physician may recommend physical therapy to apply diathermy or ultrasound to the inflamed site. These are two common modalities used to increase the temperature of the tissues in order to address both pain and inflammation. Occasionally, a Lateral epicondylitis splint or taping may be useful to help decrease stress on the elbow throughout daily activities. Exercises become very important to improve flexibility to all forearm muscles, and will aid in decreasing muscle and tendon tightness that has been creating excessive pull at the common attachment of the epicondyle.

The physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce inflammation and pain. Injections of cortisone or anesthetics are often used if physical therapy is ineffective. Cortisone reduces inflammation, and anesthetics temporarily relieve pain. Physicians are cautious regarding an excessive number of injections as they have been found to weaken the tendon's integrity. In addition, a significant number of patients experience a temporary increase in pain following corticosteroid injections.

A newer method of treatment for Lateral epicondylitis is shock wave therapy, in which pulses of high-pressure sound are directed at the injured part of the tendon. The "shock" refers to the high pressure, which breaks down scar tissue and stimulates the regrowth of blood vessels in healthy tissue. Shock wave therapy sessions take about 20 minutes and have been reported to have a success rate of 80%. Shock wave therapy has very few side effects; one group of German physicians found that temporary reddening of the skin or small bruises were the most commonly reported side effects.

Botulinum toxin, or Botox, is also being tried as a treatment for Lateral epicondylitis as of late 2003. Although further research needs to be done, Botox appears to relieve pain in chronic Lateral epicondylitis by relaxing muscles that have gone into spasm from prolonged inflammation.

Surgery

If conservative methods of treatment fail, surgical release of the tendon at the epicondyle may be a necessary form of treatment. However, surgical intervention is relatively rare.

 
 
 
 
 
 
   

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08/05/2010

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