2. TENNIS ELBOW
 TENNIS ELBOW SYNDROME
ENCOMPASSES LATERAL , MEDIALAND
POSTERIOR ELBOW SYMPTOMS.
 COMMONLY ENCOUNTERED IS LATERAL
TENNIS ELBOW-KNOWN AS CLASSICAL
TENNIS ELBOW
 IT ISTHE PAIN ANDTENDERNESSONTHE
LATERAL SIDE OFTHE ELBOW SOMEARE
WELL DEFINED AND SOMEVAGUE,THAT
RESULTS FROM REPETITIVE SRESS

3. OTHER VERIETIES
 MEDIALTENNIS ELBOW (GOLFERS ELBOW)
INFLAMMATION ATTHE ORIGIN OF
FLEXORTENDONSATTHE MEDIAL
EPICONDYLE OFTHE HUMERUS
 POSTERIOR TENNIS ELBOW-AROUNDTHE
MARGINS OF OLECRANON PROCESS

4. LOCATION OF PAIN IN T.ELBOW
 LATERAL EPICONDYLE (75%)
 LATERAL MUSCLE MASS (17%)
 MEDIAL EPICONDYLE (10%)
 POSTERIOR (8%)

5. LATERAL TENNIS ELBOW
 IT ISTHE LESION AFFECTINGTHE
TENDINOUS ORIGIN OF COMMONWRIST
EXTENSORS
 MEN>WOMEN
 BELIEVEDTO BE A DEGENERATIVE
DISORDER

7. CAUSES
 EPICONDYLITIS-DUETO SINGLE OR
MULTIPLETEARS INTHE COMMON
EXTENSOR
ORIGIN,PERIOSTITIS,ANGIOFIBROBLASTIC
PROLIFERATIONOF ECRB etc
 INFLAMMATION OF ADVENTITIOUS
BURSA-BETWEEN COMMON EXTENSOR
ORIGIN AND RADIOHUMERAL JOINT.
 CALCIFIED DEPOSITESWITH INTHE
COMMON EXTENSORTENDON

8. CAUSES
 PAINFUL ANNULAR LIGAMENT-DUETO
HYPERTROPHYOF SYNOVIAL FRINGE
BETWEEN RADIAL HEADAND CAPITULUM
 PAIN OF NUEROLOGICAL ORIGIN-CS
AFFECTION,RADIAL NERVE ENTRAPMENT
etc

9.  ECRB ISTHE MOST COMMON INVOLVED
STRUCTURE IN L.E
 MORE COMMON INTHE DOMINATEDARM

11. SEEN IN
 ALL LEVELS OFTENNIS PLAYERS(UPTO
50% AT SOMETIME IN CAREER).
 IT IS MORE COMMON IN NONTENNIS
PLAYERS(95%).
 SEEN IN OTHER SPORTSALSO (THROWING
SPORTS , SWIMMING)
 OCCUPATIONAL-CARPENTARY , PLUMPING
,TEXTILEWORKERS
 HOUSEWIVES(SQUEEZING CLOTHES)

12. PATHOPHYSIOLOGY AND RELATED
SYMPTOMS
 STAGE I : ACUTE INFLAMMATION BUT NO
ANGIOBLASTIC INVASION(PT C/O PAIN
DURING ACTIVITY)
 STAGE II:C/C INFLAMMATION+SOME
ANGIOBLASTIC INVASION(PAIN BOTH
DURINGACTIVITY AND REST)
 STAGE III:C/C INFLAMMATIONWITH
EXTENSIVE ANGIOBLASTIC INVASION(REST
PAIN,NIGHT PAINS ,PAIN DURING DAILY
ACTIVITIES)

13. CLINICAL TESTS
 LOCALTENDERNESS ONTHE OUTSIDE OFTHE
ELBOWATTHE C.E.OWITH ACHING PAIN INTHE
BACK OF FOREARM
 COZENSTEST:PAINFUL RESTRICTED EXTENSION
OFWRISTWITH ELBOW IN FULL EXTENSION
ELICITS PAIN ATTHE LATERAL ELBOW.
 ELBOW HELD IN EXTENSION,PASSIVEWRIST
FLEXIONAND PRONATION PRODUCES PAIN.
 MAUDSLEYSTEST:RESTRICTED EXTENSION OF
MIDDLE FINGER ELICITS PAIN ATTHE LATERAL
EPICONDYLE DUETO DISEASE INTHE EXTENSOR
DIGITORUM COMMUNIS

14. RADIOGRAPHY
 AP , LATERAL , RADIOCAPITELLARVIEWS
 16% CASES FAINT CALCIFICATION ALONG
L.E

15. TREATMENT
 CONSERVATIVE MANAGEMENT
REST AND PHYSIOTHERAPY (50-75%)
CHANGINGTENNIS STROKES (92%)
STREATCHING EXERCISES (84%)
USE OF SPLINTS (83%)
NSAIDS (85%)
INJECTION OF LOCAL ANAESTHETIC AND
STEROID
 BOTULINUM TOXIN TYPE ATO PARALYZETHE
COMMON EXTENSOR ORIGINTHAT HAS NOT
IMPROVED WITH CONSERVATIVE MEASURES

16.  MILLS MANOEUVRE
10% OF CASES DO NOT RESPONDTO
CONSERVATIVE MANAGEMENT
A FORCEFUL EXTENSION OF A FULLY FLEXED
AND PRONATED FOREARMAFTER INJECTION

17. SURGICAL METHODS
 PERCUTANEOUS RELEASE OF
EPICONDYLAR MUSCLES
 BOSWORTHTECHNIQUEOF EXICION OF
PROXIMAL PORTION OF ANNULAR
LIGAMENT,RELEASE OFTHE ORIGIN OF
EXTENSOR MUSCLES,EXCISIONOFTHE
BURSAAND EXCISION OF SYNOVIAL
FRINGES.

18. NEW TREATMENT MODALITIES
 USE OF EXTRACORPOREAL SHOCKWAVE
THERAPY(ESWT)
CASES OF FAILED CONSERVATIVE
TREATMENT FOR ATLEAST 6 MONTHS
2000 SHOCKWAVESTHREETIMES AT
MONTHLY INTERVALS FOR 6 MONTHS
 ARTHROSCOPIC RELEASE:OF ECRBWITH
FAILED CONSERVATIVETREATMENT FOR 6
MONTHS.MINIMALLY INVASIVE AND HELPS
IN EARLY REHABILITATION.

19. NEW TREATMENT MODALITIES
 AUTOLOGUS BLOOD INJECTIONS:IN
REFRACTORY CASES,INJECTION OF 2 ML OF
AUTOLOGUS BLOODAND 0.5% BUPIVICAINE HAS
BEENTRIED
 COUNTERFORCE BRACING(TENNIS ELBOW OR
FOREARM BAND):THESE FORCES RELEASETHE
FORCES INTHE ECRB REGION
 REHABILITATIVE EXERCICES:WRIST FLEXION ,
EXTENSION,FOREARM SUPINATION AND
PRONATION,WRIST RADIAL AND ULNAR
DEVIATIONS AT 3 SETS OF 10 REPETITIONS
EVERYDAY FOR 3TO 6 MONTHS(KNOWNTO GIVE
GOOD RESULTS)

20. NEW TREATMENT MODALITIES
 USG GUIDED PERCUTANEOUS NEEDLE
THERAPY:USG GUIDED CORTICOSTEROID
INJECTION AND NEEDLE DEBRIDEMENT OFTHE
STRUCTURES AROUND LATERAL EPICONDYLE.
INDICATION:SMALLTEARS,NOT RESPONDINGTO
CONSERVATIVETHERAPY AND IFTOO SMALL FOR
SURGERY
ADVANTAGES :MINIMALLY INVASIVE PROCEDURE
RESTORATION OF FUNCTION IS RAPID
THE OPTION OF SURGERY IS STILL OPEN
IN EXPERT HANDS IT HAS SUCCESS RATE OF 65%

21. PROGNOSIS
 RESPONSETO INITIALTHERAPY IS
COMMON,BUT SOARE RELAPSE(18-
50%)AND /OR PROLONGED,MODERATE
DISCOMFORT(40%)