Tennis elbow is not a tendonitis. It´s a tendinosis.

tennis elbowThe first description of tennis elbow “tennis elbow” is found in German litterature in 1873 under the name of “writer’s cramp” in reference to the population in which it was observed.

The pain in the outside compartment of the elbow – external elbow tendonitis -, has been the subject of numerous publications, but this syndrome remains poorly understood and scientific certainty is low. A Medline search with the keyword “lateral epicondylitis” finds 1338 references.

The term epicondylalgia for elbow tendonitis is presently preferred to those, almost synonyms, like tennis elbow, epicondylitis, tendinitis of radial insertion tendinopathy… to describe a lateral elbow pain that takes place in the area of the tendon.

The diagnosis of tennis elbow or epicondylalgia obviously implies that other causes of elbow pains (such as arthritis, tumors, neuralgia C7 truncated …) have been eliminated.

The common name tennis elbow, for elbow tendonitis, should literaly cover all diseases of the elbow a tennis player can come across. In reality, it is aimed at projective pains of the epicondyle : the epicondylalgias.

Few studies among the general population or in the workplace are focused on elbow tendonitis. There are relatively more studies on tennis elbow, conducted in populations of athletes. They are informative, because the consequences of hyper-stress, whether work-related or sports, may be similar.

Tendonitis of the elbow or lateral epicondylitis.

Tennis elbow is a tendinitis, or tendinosis of insertion, of epicondylar muscles, most often the second radial, sometimes the extensor digitorum communis or supinator and very rarely, the extensor carpi ulnaris and V.

Epicondylitis or tennis elbow is definitely the best known sports affection, because of its frequency and its difficulty to cure. If elbow tendonitis mostly concerns tennis players, it can also occur in other sports, such as golf, javelin, baseball or any other sport requiring strong grasping reflex.

This elbow tendonitis can also occur outside of any sports crafts – screwing, hammering. – The tennis elbow is manifested by a pain sitting at the outside of the elbow, sometimes radiating to the forearm and hand.

Common signs and symptoms of tennis elbow include :

– Pain or burning on the outer part of your elbow

– Weak grip strength

Pain caused by the tennis elbow -tendonitis of the elbow- occur early in the sport and gradually occurs during anodyne gestures of everyday life : a hand shake, the lift of a mineral watter bottle, a key turn in a lock, etc. …

For elbow tendonitis, the terms often used of tennis elbow for lateral epicondylitis and golfer’s elbow for medial epicondylitis show the importance given to sports factors for these conditions.

Medial elbow tendonitis are less common than lateral epicondylitis. This is probably due to the fact that tennis elbow, or elbow tendinitis, will occur in sports soliciting the wrist extensors like tennis for example. Clinically, we find in both elbow tendonitis pain on palpation, stretching and contraction tests. Tensioning in elbow extension will significantly increase the stress stretching for lateral epicondylar muscles. For medial epicondylar the stretch constraint is related to the extension of the wrist.

test tennis-elbowIsometric tests in lateral elbow tendinitis essentially concerns the wrist extensors, the short extensor carpi radialis. In the medial tendonitis, the most sensitive test concerns the isometric muscle pronator who will more often be incriminated as wrist flexors. This is why during my clinical exam of medial tendonitis, I make a test with a flexed elbow in resisting pronation.

On the etiology, the majority of lateral elbow tendinitis correspond to isolated tendinopathies , although in some cases I find a joint injury or cervical origin.

In contrast, in the medial elbow tendinitis, the proximity to other anatomical structures, nerves and ligaments, results that there are often associated pathologies.

Finally, medial elbow tendonitis are sometimes the result of shoulder pathologies, especially neurological.

Medial elbow tendonitis are disabling in the practice of sports, especially those requiring a strong grip (racket, bat, handlebars, etc …)

If the clinical diagnosis of tennis elbow is easy to establish, one difficulty lies in finding differential diagnoses or associated lesions of the ulnar nerve, ulnar collateral ligament, a compartment syndrome and other tendinopathies of the elbow.

The analysis of factors related to the prevalence of medial elbow tendinitis shows a clear link between the presence of this disease and having to “work” in force. As for lateral elbow tendinitis, the risk of onset for subjects without, increases with the number of other diseases of the upper limb.

The treatment of tennis elbow – elbow tendonitis

In addition to the analgesic treatment protocol for an elbow tendonitis, it must be based on a rehabilitation program involving stretching, strengthening especially eccentric and concentric muscle incriminated.

The importance of early prevention, identification of musculoskeletal disorders and disorders get worse, to avoid situations of accumulation of several musculoskeletal disorders and thus avoid tendonitis of the elbow.

25 August 2018 - 10 h 45 min

Treatment of the tennis elbow