Introduction

Lateral and medial epicondylitis are diagnostic terms that describe the constellation of pain and localized tenderness at the epicondyles of the distal humerus. Major originally coined the term tennis elbow in 1883.1 This eponym remains despite the fact that 95% of affected people are not tennis players.2 However, 10% to 50% of persons who regularly play tennis will, at some time, experience symptoms characteristic of this disorder.3

Lateral epicondylitis is far more common than medial epicondylitis, with ratios of reported incidences ranging from 4:1 to 7:1.4-6 The incidence is equal among men and women, with male tennis players affected more often than female players. The average peak age distribution is 42 years (range, 30 to 50 years). A bimodal distribution is present: acute onset of symptoms is much more common in young athletes, and the chronic, recalcitrant pattern most often occurs in older individuals.

The cause of the disorder seems to be repetitive eccentric or concentric overloading of the flexor or extensor muscle masses. It affects the dominant extremity twice as often as the nondominant extremity. Most cases are related to occupational exposure and cause subacute or chronic symptoms. Only 10% to 20% of patients, usually young tennis players (lateral) or throwing athletes (medial),4 have an acute injury.

In athletes, the occurrence of lateral epicondylitis is almost exclusively limited to tennis players. The pain commonly is felt on the backhand stroke when the wrist extensors are actively stabilizing the racquet to absorb the impact from the ball. If medial epicondylitis is present in a tennis player, the pain can be reproduced on the forehand, serve, or overhead stroke.5

Medial epicondylitis can affect golfers or throwing athletes. Baseball pitchers and javelin hurlers are particularly susceptible, because their specialized throwing styles place considerable strain on the flexor-pronator origin. The valgus overload that these throwing motions produce also predisposes athletes to acute or chronic medial ligamentous insufficiency.

In 1969, Nirschl reported his observation of "mesenchymal syndrome."7 This term described a subset of patients who seemed predisposed to tendinitis. Repetitive overuse of the affected extremities commonly was not present. This unique group of patients constituted about 15% of cases. The involved patient typically was a woman between 35 and 55 years of age. In these patients, Nirschl identified varying combinations of disorders, including rotator cuff tendinopathy, medial epicondylitis, ulnar neuropathy, lateral epicondylitis, carpal tunnel syndrome, DeQuervain's tenosynovitis, and trigger finger. Almost invariably, the rheumatologic evaluation was negative. This finding led to the postulation that constitutional factors, such as estrogen deficiency or a hereditary predisposition to tendon degeneration, predisposed a patient to generalized tendinitis.

In this chapter, we discuss the pathology, clinical presentation, and treatment of lateral and medial epicondy-litis. After briefly describing nonoperative treatment, we focus on the operative techniques for treating these disorders and touch on postoperative care, results, and failures.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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