Lateral epicondylosis | CMAJ

Lateral epicondylosis | CMAJ

Lateral epicondylosis (tennis elbow) is a degenerative, noninflammatory situation of the frequent extensor origin on the lateral epicondyle of the elbow

Tennis elbow has a prevalence of 1%–3%, peaking at age 35–50 years.1 It’s related to smoking and with a mix of repetitive and forceful handbook actions.2

The analysis is medical based mostly on lateral elbow ache and epicondyle tenderness

Provocative assessments embody ache with resisted extension of the lengthy fingers or wrist when the elbow is prolonged. Ache distal to the epicondyle suggests radial tunnel syndrome and warrants orthopedic referral. Clinicians ought to receive radiographs for sufferers with lack of vary of movement, locking or catching of the elbow to evaluate for osteoarthritis and osteochondritis dissecans. Ultrasonography and magnetic resonance imaging have variable sensitivity and specificity, and should not routinely required.1

Signs of tennis elbow are managed with physiotherapy and anti inflammatory brokers

Eccentric strengthening of the frequent extensor origin (Appendix 1, obtainable at www.cmaj.ca/lookup/doi/10.1503/cmaj.211047/tab-related-content) reduces ache and improves operate and grip power.2 Topical nonsteroidal anti-inflammatory medicine (NSAIDs) scale back ache (quantity wanted to deal with = 7) with few antagonistic results, however oral NSAIDs present unclear profit with a threat of gastrointestinal antagonistic results.3

Corticosteroid injections needs to be prevented

Corticosteroid injections present solely short-term ache reduction and end in decrease charges of symptom decision or enchancment (quantity wanted to hurt [NNH] = 8) and higher threat of symptom recurrence (NNH = 2) than placebo injections at 1 yr.4 The efficacy of platelet-rich plasma is unclear, given variation in its preparation and lack of superiority to placebo in underpowered research.5

Referral for surgical procedure needs to be thought-about after 6 months of failed nonoperative administration

Tennis elbow is often self-limiting, and 90% of sufferers get better inside 1 yr. Those that don’t reply after 6 months of nonoperative remedy are more likely to have a protracted illness course of greater than 2 years and are potential candidates for surgical procedure.6 Open, arthroscopic or percutaneous débridement of the frequent extensor origin has been proven to enhance ache and performance scores, with good-to-excellent outcomes in 80% of sufferers.6

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