Effective Home Remedy to Cure Tennis Elbow

Tennis Elbow Treatment

All too many people every year run up a huge medical bill and spend a lot of time in physical therapy in an attempt to treat their tennis elbow But there is a better way! Often, traditional medical professionals don't know how to treat tennis elbow in a way that actually sticks. But now you know better! Learn how to treat your tennis elbow with this quality ebook guide that gives you the real advice that no one talks about You will be amazed at the results that you are able to get! You don't even need to break a sweat or get on a really tough exercise program And you don't need to waste time in order to get back to full health! Follow our treatment plan, and you will be back to full health and no pain in no time! All that it takes is a bit of time and you will back to full health just like that! Read more...

Tennis Elbow Secrets Revealed Overview


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Author: Geoff Hunt
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Tennis Elbow Secrets Revealed

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Fixing Elbow Pain

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Tennis Elbowand Golfers Elbow Cure

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Tennis Elbowand Golfers Elbow Cure Overview

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Lateral Epicondylitis and Lateral Collateral Ligament Injury

Epizondylus Radial

Lateral epicondylitis, also called tennis elbow, is caused by degeneration and tearing of the common extensor ten-don.22 This condition often occurs as a result of repetitive sports-related trauma to the tendon, although it is seen far more commonly in nonathletes.9 In the typical patient, the degenerated extensor carpi radialis brevis tendon is partially avulsed from the lateral epicondyle.22 Scar tissue FIGURE 4.4. Clinically suspected tennis elbow in a patient who did not respond to a local steriod injection. A STIR coronal image (A) and a T2-weighted axial image (B) reveal a completely normal common extensor tendon (open arrows) and increased signal within the adjacent extensor carpi radialis longus muscle (solid arrows) secondary to a recent steroid injection. Abnormal signal may persist for weeks after an injection and be mistaken for primary muscle pathology on MRI. forms in response to this partial avulsion, which then is susceptible to further tearing with repeated trauma....

Clinical Presentation Of Medial Epicondylitis

Medial epicondylitis is also known as golfer's elbow. It is far less common than lateral epicondylitis. Typically, the patient profile is similar to that for lateral epicondylitis. The exception is the young (i.e., 15 to 25 years of age) throwing athlete who presents with either acute or subacute onset of symptoms. Tenderness is present at the origin of the common flexor tendon at the medial epicondyle. Resisted wrist flexion with the forearm supinated or resisted pronation reproduces the patient's pain. The examining physician should carefully evaluate the ulnar nerve for signs of neuritis because these conditions commonly coexist. Nirschl reported a 60 incidence of ulnar nerve entrapment in association with medial epicondylitis.11 Most commonly, the site of entrapment was distal to the medial epicondyle (Nirschl's zone III) where the nerve passes between the heads of the flexor carpi ulnaris. In throwing athletes, assessing the integrity of the ulnar collateral ligament is...

Medial Epicondylitis

Epizondylus Radial

Medial epicondylitis, also known as golfer's elbow, pitcher's elbow, or medial tennis elbow, is caused by degeneration of the common flexor tendon secondary to overload of the flexor-pronator muscle group that arises from the medial epicondyle.7-9 The spectrum of damage to the muscle-tendon unit that may be characterized with MRI includes muscle strain injury, tendon degeneration (tendinosis), and tendon disruption (Fig. 4.3). FIGURE 4.3. A 42-year-old golfer with persistent symptoms of medial epicondylitis after a steroid injection. T1-weighted (A) and STIR (B) coronal images reveal detachment of the common flexor tendon from the medial epicondyle (curved arrows). The underlying anterior bundle of the MCL (straight arrows) appears normal. FIGURE 4.3. A 42-year-old golfer with persistent symptoms of medial epicondylitis after a steroid injection. T1-weighted (A) and STIR (B) coronal images reveal detachment of the common flexor tendon from the medial epicondyle (curved arrows). The...

Posterior Dislocation Injury and Instability

We have found MRI to be very reliable in detecting rupture of the LUCL. This ligament usually tears proxi-mally at the lateral margin of the capitellum and is best evaluated on coronal and axial images.5,32 The LUCL may tear as an isolated finding on MRI in patients who have posterolateral rotatory instability in stage 1. Tears of the LUCL also may be detected in association with rupture of the MCL in stage 3B. Disruption of the LUCL is commonly seen in patients who have severe tennis elbow and tears of the common extensor tendon on MRI.

Posterior Extension Injuries

The patient presents with vague posterior elbow pain and an inability to fully extend the elbow. The physical examination reveals tenderness at the olecranon or triceps insertion, or both, and pain with elbow extension against resistance. The radiographs show an irregular pattern of olecranon apophysis ossification (sclerosis, widening, or fragmentation) compared with the uninvolved side. An MRI shows apophyseal edema or physeal separation, triceps tendon edema (tendinosis), and degeneration or detachment.

Nonoperative Treatment

Improved throwing mechanics and endurance exercises are stressed for throwers. The importance of a proper warm-up and stretching cannot be overemphasized. For tennis players, alterations in grip size, racquet weight, and string tension are significant for the treatment and prevention of lateral epicondylitis.

Postoperative Management

Initially, patients wear a posterior splint for 1 week after surgery. When the splint is removed, the patient begins range-of-motion exercises of the wrist and elbow. Once motion is regained, a gradual program of strengthening that concentrates on endurance is undertaken from week 4 to week 6 after surgery. A counterforce brace is employed during the rehabilitation phase. Return to competitive athletics or the workplace is restricted until full strength has returned to the extremity. Patients need to be counseled against the temptation to return too quickly. The usual return to activities is 4 months after surgery for lateral epicondylitis. After surgery for medial epi-condylitis, the patient should expect to return after 5 or 6 months the return will take longer if the patient had a concomitant ligament reconstruction.

Provocative Tests Lateral

Chair Lift Test Tennis Elbow

Stress to the extensor carpi radialis longus and brevis muscles reproduces the discomfort associated with lateral epi-condylitis. To create this stress, the patient fully extends the elbow and resists active wrist and finger extension (Fig. 3.15). This maneuver elicits pain at the lateral epicondyle and is the most sensitive provocative maneuver for lateral epicondylitis. Passive flexion of the wrist with the elbow extended also can cause discomfort because it stretches the extensor tendons. Finally, the chair test can help the examiner diagnose lateral epicondylitis.27,28 In this test, the patient raises the back of a chair with the elbow in full extension, the forearm pronated, and the wrist dorsiflexed (Fig. 3.16). Before he or she raises the chair, a patient who has lateral epicondylitis often exhibits apprehension. FIGURE 3.15. Test for lateral epicondylitis. Stress to the origin of extensor carpi radialis brevis and longus tendons, which is created by resisting active wrist...

Authors Preferred Method

Sublime Tuercle Elbow

The arthroscopic evaluation permits visualization of the anterior and posterior compartments. The surgeon evaluates the anterior compartment for loose bodies and spur formation and examines the capitellum surface for reciprocal chondral lesions, which occur in acute or chronic UCL deficiency, and for osteochondritis disse-cans lesions (Fig. 7.8). Application of a valgus stress produces from 2 to 3 mm of opening between the medial ul-nohumeral joint in patients who have UCL insufficiency and serves as a useful diagnostic confirmation when ligament instability is uncertain.18 Although only 20 to 30 of the anterior bundle is visible from the anterior portal,16 medial elbow stability can be assessed during arthroscopic surgery.

Physical Examination And Diagnosis

Because the injuries occurring in throwing athletes are complex and subtle, the treating physician needs to take a detailed history and complete a thorough physical examination of the injured athlete. Finding concomitant shoulder and elbow pain in the thrower is common. The patient may have only slight discomfort with throwing, but may have a subjective and documented decrease in Inspection of the elbow may reveal increased valgus alignment and usually reveals a flexion contracture ranging from 5 to 20 . Palpation of the posteromedial aspect of the elbow in full extension reveals tenderness on the olecranon tip and in the olecranon fossa. This tenderness is best appreciated with the elbow in 45 of flexion. Tenderness in the posterior region that is more proximal or distal to the olecranon tip is present in triceps tendinitis or in an olecranon stress fracture,18 respectively. Palpable loose bodies in the posterior compartment may be an additional finding. The examiner should palpate...

History And Physical Examination History

A detailed history and physical examination is essential in evaluating the elbow for UCL insufficiency. Most athletes who present for evaluation participate in activities involving repetitive overhead throwing motions. Knowledge of previous elbow injuries and treatments aids the examiner in the initial examination. The chronology of the development of elbow pain can give clues to the underlying problems and can indicate where the injury lies on the spectrum of UCL injury. Pain in the medial portion of the elbow with throwing beyond 60 to 75 of maximal effort can indicate ligament attenuation. Athletes who have ligament attenuation often have a history of recurrent medial elbow injury and might sense movement in the elbow when attempting to throw beyond 75 of maximal effort. In a chronic case of UCL insufficiency, the athlete might experience mechanical symptoms, such as locking and catching, or crepitation, that suggest the presence of loose bodies or early degenerative changes in the...

Gracilis muscle dissection and muscle insertion

Gracilis Myocutaneous Flap

Doi 26 preferred to use the T3-6 IC nerves for the second FFMT procedure T5-6 IC nerves for a second FFMT for finger flexion, and T3-4 IC nerves to innervate the motor branch of triceps for simultaneous elbow extension. The author prefers to use the three T3-5 IC nerves for FFMT reinnervation either for elbow flexion or for FDP function 28,29 . The IC nerve has a deep central branch and a superficial lateral branch, but only the deep central branch is used for reinnervation. The gracilis myocutaneous FFMT is usually fixed at the coracoid process for elbow flexion, but fixed at the second or third rib for finger flexion. For finger flexion, the muscle passes through a subcutaneous tunnel to the medial elbow incision where the pronator teres and long wrist flexor muscle origins are elevated to form a below-elbow pulley. The muscle is passed under the pulley and is sutured to the FDP by weaving it under tension.

Lateral Compression Injuries

The patient is usually older than 13 years of age and presents with an insidious onset of poorly localized lateral elbow pain while throwing. The physical examination reveals radiocapitellar tenderness and possible joint effusion. In a series by Gill and Micheli, 79 of the cases revealed effusion and radiocapitellar tenderness.8 The patient's range of motion is diminished. There can be a progressive flexion contracture (> 15 ) and, sometimes, locking or catching from loose bodies.5,23

Medial Approach

Jobe describes a medial utility approach for medial collateral ligament reconstruction and for the treatment of medial epicondylitis (Fig. 1.26).69 A curvilinear incision is made over the anterior aspect of the medial epi-condyle, and care is taken to identify and preserve the multiple medial antebrachial cutaneous nerve branches that are encountered. The common flexor tendon can then be divided in line with its fibers or reflected distally to expose the medial capsule and ligaments.


Careful inspection of the elbow joint and surrounding areas is the next step in evaluating elbow injury. First, the examiner should note atrophy or hypertrophy of muscle groups of the arm or forearm and should obtain girth measurements. Hypertrophy of the forearm musculature often is present in the dominant extremity of the throwing athlete and should be considered a normal variant. Atrophy of arm and forearm musculature, however, might result from an underlying neurologic disorder.

Stability Testing

Either an acute traumatic event or a chronic overload syndrome can result in valgus instability of the elbow. Attenuation or rupture of the anterior oblique bundle of the UCL causes this pattern of instability.1,21,22 Medial elbow stability is tested with the patient sitting, the patient's elbow flexed from 20 to 30 to unlock the olecranon from its fossa, and the patient's forearm secured between the examiner's arm and trunk1 (Fig. 3.12). While apply-


The most sensitive indirect maneuver for the diagnosis of medial epicondylitis is resisted forearm pronation, which is positive in 90 of patients who have this disorder29 (Fig. 3.17). A positive test elicits pain at the flexor-pronator muscle mass origin on the medial epi-condyle. The second most sensitive maneuver is resisted palmar flexion, which is positive in 70 of patients.29 Passive extension of the wrist and fingers also can elicit pain at the medial epicondyle in these patients. FIGURE 3.17. Resisted forearm pronation elicits pain at the medial epicondyle in patients who have medial epicondylitis. FIGURE 3.17. Resisted forearm pronation elicits pain at the medial epicondyle in patients who have medial epicondylitis.


MRI imaging provides clinically useful information in assessing the elbow joint. Superior depiction of muscles, ligaments, and tendons and the ability to directly visualize nerves, bone marrow, and hyaline cartilage are advantages of MRI relative to conventional imaging techniques. Ongoing improvements in surface coil design and newer pulse sequences have resulted in higher-quality MRI of the elbow. Traumatic and degenerative disorders of the elbow are well seen with MRI. The sequelae of medial traction and lateral compression from valgus stress include medial collateral ligament injury, common flexor tendon abnormalities, medial traction spurs, ulnar neuropathy, and osteochondritis dissecans. These conditions, as well as lateral collateral ligament injury and lateral epicondylitis, may be characterized with MRI. Post-traumatic osseous abnormalities well seen with MRI include radiographically occult fractures, stress fractures, bone contusions, and apophyseal avulsions. MRI also can...


Hooper,2 and Nirschl and Pettrone10 demonstrated that the condition is actually a degenerative tendinopathy. Goldie9 described granulation tissue found at the extensor carpi radialis brevis (ECRB) origin, but did not describe any tearing of the tissue. Coonrad and Hooper first described macroscopic tearing in association with the histologic findings in 1973.2 Nirschl termed this histologic process angiofibroblastic tendinosis. It is characterized by disorganized, immature collagen formation with immature fibroblastic and vascular elements.3 This gray, friable tissue is found in association with varying degrees of tearing in the involved tendinous origins. The most common anatomic locations of the tendinosis are the ECRB tendon laterally and the pronator teres and flexor carpi radialis medially. Universally, the ECRB tendon is involved in lateral epicondylitis.11 A bony exostosis, or traction spur, can be identified at the lateral epicondyle in 20 of patients.

Surgical Results

In patients who have undergone resection and repair for recalcitrant lateral epicondylitis, a success rate of more than 90 can be expected.4,10,12,16 Nirschl reported a total of 97 good to excellent results in his series.10 Eighty-five percent of the patients had a full return to activity and complete absence of pain, and 12 had pain only with aggressive activities.10 Glousman reported similar results in 1991, with 94 of the 60 patients in his series experiencing significant improvement in their symp-toms.29 Medial epicondylitis results need to be assessed carefully because concomitant ulnar neuropathy affects the outcome. Gabel and Morrey reported less than 50 good to excellent results in patients who had moderate or severe ulnar neuropathy compared with more than 90 in


In 1992, Nestor et al. reported the results of eleven patients who had reconstruction of the lateral elbow for recurrent posterolateral rotatory instability.1 In the five patients who had reconstruction with a palmaris longus tendon graft (the currently preferred method), three had an excellent result. The authors believed that a previous operation to the lateral elbow was a possible negative prognostic factor to a good or excellent result.


Findings with the radiographic features of elbow abnormalities in overhead throwing athletes in his study on javelin throwers. Bennett5 is credited with first describing specific injuries in the pitcher's elbow in 1941. In addition, he anecdotally reported the successful removal of loose bodies and the return of the athletes to competition. In 1959, he described spurs in the posterior compartment that he believed were part of the spectrum of lesions he had noted 18 years earlier.6 King et al.10 pointed out that about 50 of baseball pitchers have flexion contractures and 30 have cubitus valgus deformity. They coined the term medial elbow stress syndrome. Their description of the olecranon osteophyte and medial olecranon fossa hypertrophy leading to impingement is similar to VEO as it is recognized today. Slocum11 recognized the repetitive stresses that were placed on the elbow during pitching and the associated clinical and radiographic changes that result from these stresses. He...

Functional Anatomy

Lateral elbow instability is most commonly a posttrau-matic condition. In most instances, the injury involves a combination of axial compressive, external rotatory, and valgus forces applied to the elbow.3,4 Researchers also have proposed varus extension as a mechanism of injury.1 It also may have an iatrogenic origin, because this instability has been reported following overly aggressive de-bridement of the lateral soft tissues for recalcitrant lateral epicondylitis, or tennis elbow.1,5 The lateral collateral and annular ligament complex represents the primary restraint to posterolateral elbow instability. This structure maintains the ulnohumeral and radiocapitellar joints in a reduced position when the elbow is loaded in supination. Principal secondary restraints of the lateral elbow consist of the extensor muscles with their fascial bands and intermuscular septa.6 By virtue of their course alone, the extensor muscles serve to independently support the forearm unit from laterally...


Epicondylar Bursitis Elbow

Vers to ensure that he or she has made the correct diagnosis. For patients who have medial epicondylitis, the presence of ulnar nerve symptoms and signs is important to note so that, if indicated, the nerve can be released appropriately. Quality anteroposterior, lateral, and oblique radiographic views should be assessed for the presence of calcification or a bony exostosis (Fig. 6.3). In patients who have medial epicondylitis, a cubital tunnel, or pos-teroanterior axial, view can be substituted for the oblique view. Surgical treatment of lateral epicondylitis has been directed toward the structures that the surgeon believes are abnormal elements. Bosworth initially described excision of the orbicular ligament in 1955 he later modified his procedure to include release of the ECRB.13 Other procedures involve removal of a radiohumeral bursa or excision of the radiohumeral synovial fringe.4 Procedures to address possible neurologic causes include denerva-tion by neurotomy of articular...

Arm Cocking

Maximum Voluntary Torque Elbow Flexors

Repetitive valgus loading eventually may lead to injury to the ulnar collateral ligament (UCL). Furthermore, inflammation of the medial epicondyle or adjacent tissues may occur (i.e., medial epicondylitis). Valgus torque also can cause high compressive forces on the lateral elbow, which can lead to lateral elbow compression injury.20 Specifically, valgus torque can cause compression between the radial head and humeral capitel-lum.30 According to the in vitro study by Morrey and An, joint articulation supplies 33 of the varus torque needed to resist the valgus torque that the forearm applies.11 Thirty-three percent of the 52- to 76-N-m maximum varus torque generated during pitching is 17 to 25 N-m. If the distance from the axis of valgus rotation to the compression point between the radial head and the humeral capitellum is approximately 4 cm, then the compressive force generated between the radius and humerus to produce 17 to 25 N- m of varus torque is approximately...

Physical Examination

Palpation over the ligament usually elicits tenderness along its course when the athlete has an acute injury. The anterior bundle of the UCL originates at the anteroinfe-rior portion of the medial epicondyle of the humerus and inserts on the medial border of the coronoid process at the sublime tubercle.16,17 Pain at the ligament's origin can mimic medial epicondylitis or, in extreme injury, rupture of the flexor-pronator muscle mass origin.12,22,23 Pain elicited at the origin of the tendon with resisted wrist flexion, resisted forearm pronation, or firm fist clench differentiates the isolated UCL injury from these other injuries. amination, the patient places the opposite hand under the elbow and grasps the thumb of the injured arm. With the injured elbow flexed to more than 90 , the patient applies a valgus stress to the elbow by pulling the thumb with the opposite hand. Hyperflexion isolates the anterior bundle of the UCL, and valgus stress stretches it. Positioning the elbow in...


Lateral Elbow Positioning

Patients who have lateral elbow instability present with a variable history and symptoms. Previous trauma can involve a documented dislocation of the elbow or an injury without dislocation. Patients report a sensation of their elbow intermittently giving way or going out. Common mechanical symptoms include popping, catching, or snapping of the elbow. The symptoms typically manifest during loading of the joint in a slightly flexed position with the forearm in supination, such as when picking up a heavy briefcase. In patients whose elbows are more unstable, these episodes can occur with very minor loading, such as when turning over in bed during sleep. FIGURE 8.2. The deep (above) and superficial (below) layers supporting the lateral elbow. The deep layer consists of the lateral collateral and annular ligament complex with the tightly opposed overlying tendinous fibers of the supinator muscle. The superficial layer comprises the extensor tendons and their intermuscular fascia and septa....

Surgical Failure

The surgical procedures to address tennis elbow are extremely reliable. Success rates of approximately 90 can be expected. Typically, the most common cause of perceived surgical failure is a return to activity that is too aggressive. In the absence of secondary gain issues (i.e., workers' compensation claims), pain from 6 to 9 months after surgery is unusual in a compliant patient. Diagnostic injections can be very useful in the evaluation of failed tennis elbow surgery. Morrey presented a logical algorithm for the evaluation of failed procedures (Fig. 6.12).30 Injections can be used at the epicondyle or at the arcade of Frohse to differentiate posterior interos-seous nerve compression from persistent lateral epicondylitis. Fluoroscopy or arthrography can be used to evaluate potential instability. The arthrogram also demonstrates bursal or capsular defects. If a definitive diagnosis can be made with the use of the algorithm, surgical treatment can be recommended.

Football Passing

Although football passing is qualitatively similar to baseball pitching, it requires markedly less force and torque production to decelerate elbow extension than pitching requires. The lower incidence of elbow injury in quarterbacks who repetitively throw than in baseball pitchers may be attributed to the lower forces and torques generated during the deceleration phase.

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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