The scientific name of tennis elbow, “lateral epicondylitis”, designates an inflammation that occurs in the vicinity of a small bony protrusion of the arm bone (humerus), just above the elbow joint on the outer face. of the arm. Sometimes, however, other areas of the forearm and elbow are painful. In epicondylitis, current knowledge speaks in favor of degenerative tendon involvement and is no longer inflammatory. Thus, the term tendinopathy is now preferred instead of tendonitis.
Lateral epicondylitis
Lateral epicondylitis affects men and women equally, usually between the ages of 35 and 55. A recent systematic review concluded that the risk factors for developing lateral epicondylitis are mostly occupational and include: active or previous smoking, typing, playing the piano, using tools greater than 1 kg, handling loads over 20 kg more than 10 times per day, and pronation/supination of the wrists with elbows extended for more than 2 hours per day.
Lateral epicondylitis is also classically linked to sports, mainly racket sports (tennis) and throwing (baseball, javelin). In tennis players, 20-50% of regular players will develop lateral epicondylitis in their lifetime, especially in amateurs compared to elites
Treatment and management
The goal of treatment includes treating pain, maintaining mobility, improving grip strength and endurance, normalizing function, and monitoring possible clinical deterioration. The education of the patient is essential here concerning the causes and the length of evolution.
The treatment can be separated into three phases: the acute phase is treated with ice, compression, rest, and possibly NSAIDs; the subacute phase includes coordinated rehabilitation, stretching, possibly wearing an elbow pad or infiltration; finally, the phase of returning to activity, too often ignored.
Management also involves changes inhabit and the avoidance of aggravating activities. There are many methods of physiotherapy. The most used are stretching, eccentric or concentric strengthening exercises (for example, protocol according to Stanish), transverse massages, and manipulations. The purpose of extracorporeal shock waves (ODC) is to stimulate the tendon healing process.
Medial epicondylitis
Medial epicondylitis is less common than lateral epicondylitis in the general population. Risk factors for this condition include smoking, obesity, repetitive wrist movements, and frequent elbow flexion/extension. Athletes playing golf, tennis (especially elite), baseball, archery, and rock climbing are at risk, especially because of the acceleration phase of the flexor and pronator muscles while the elbow is in the extension-valgus.
The treatment is mainly done by analogy with lateral epicondylitis. The latter consists of the first phase of rest, or even treatment with NSAIDs. Thereafter, physiotherapy may involve passive stretching or concentric or eccentric strengthening exercises.
Epicondylitis is a common pathology, most often treated by the family doctor. Most patients progress favorably with conservative treatment with their physiotherapist if the triggering factor, occupational or sports can be found and corrected.
