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Finding information(1)Finding information(1)

28/3/0628/3/06

O.ArikaweO.Arikawe

Tennis elbowTennis elbow

DEFINITION: DEFINITION: pain and tenderness over the lateral pain and tenderness over the lateral

epicondyle and pain on resisted wrist epicondyle and pain on resisted wrist extension.extension.

INCIDENCE:INCIDENCE: 4 – 7 / 1000 per year in general 4 – 7 / 1000 per year in general

practice.practice.Peak incidence between 40 -50 years.Peak incidence between 40 -50 years.

AETIOLOGYAETIOLOGY

repeated strain result in inflammation repeated strain result in inflammation of the common extensor tendon of the common extensor tendon where it inserts into the epicondylewhere it inserts into the epicondyle

It could also occur after minor or It could also occur after minor or unrecognized trauma of the extensor unrecognized trauma of the extensor muscles of the fore arm. muscles of the fore arm.

Tennis is a direct cause in only about Tennis is a direct cause in only about 5%.5%.

PROGNOSIS:PROGNOSIS: self limiting.self limiting. minority of cases persist for 18 months to 2 minority of cases persist for 18 months to 2

years or longer.years or longer. 10% - 20% of episodes result in 12 weeks 10% - 20% of episodes result in 12 weeks

absence from work. absence from work.

Sources of informationSources of information

Clinical evidenceClinical evidence BandolierBandolier medline/medscapemedline/medscape On medicaOn medica Doctors.net.uk/pubmedDoctors.net.uk/pubmed Nice guidelinesNice guidelines TextbooksTextbooks Journals – BMJ, BJGPJournals – BMJ, BJGP

Possible treatments for tennis Possible treatments for tennis elbowelbow

Topical NSAIDS for short term pain reliefTopical NSAIDS for short term pain relief oral NSAIDS for short term pain relieforal NSAIDS for short term pain relief Corticosteroid injectionsCorticosteroid injections AcupunctureAcupuncture Exercise and mobilizationExercise and mobilization NSAIDS for longer term pain reliefNSAIDS for longer term pain relief Braces(orthoses)Braces(orthoses)

SurgerySurgery Extra corporeal shock wave therapyExtra corporeal shock wave therapy PhysiotherapyPhysiotherapy Botulinum toxin injectionBotulinum toxin injection Topical nitric oxide patchTopical nitric oxide patch Ionotophoretic steroid deliveryIonotophoretic steroid delivery

Best treatment optionBest treatment option

Topical NSAIDS for short term pain relief.Topical NSAIDS for short term pain relief.

Evidence:Evidence:

cochrane cochrane review abstract based on meta-review abstract based on meta-analysis of controlled clinical trialsanalysis of controlled clinical trials

Clinical evidenceClinical evidence search and appraisal search and appraisal April 2003 April 2003