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  • Lateral tendon injury
  • Lateral tendonitis
  • Lateral humeral epicondylitis
  • Tennis elbow
  • Lateral tennis elbow

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  • 726.32 Lateral epicondylitis

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  • M77.10 Lateral epicondylitis, unspecified elbow

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Description

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  • Tendinosis of wrist extensor tendons that attach at the lateral humeral epicondyle
  • Normal collagen response is disrupted by fibroblastic, immature vascular response and an incomplete reparative phase
  • Early stages may display inflammatory or synovitic characteristics
  • Later stages may demonstrate microtearing, tendon degeneration with or without calcification, or incomplete vascular response
  • Pain in lateral elbow with resisted wrist extension and radial deviation with elbow extended

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Essentials of Diagnosis

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  • Tendonitis of the elbow rarely caused by acute trauma except in sports-related events, such as tennis
  • Usually affects middle-aged clients; aging process leads to decreased mucopolysaccharide chondroitin sulfate within tissues, making tendons less extensible
  • Age-related tissue changes for tennis elbow appear in patients aged 35 years and older

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General Considerations

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  • Tendinosis affecting the elbow is rarely acute unless direct trauma (then considered tendonitis)
  • Pain usually associated with activity, more so afterward
  • Onset of pain associated with wrist extension, elbow extension, and forearm pronation activities
  • Direct blows to lateral epicondyle can initiate symptoms

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Demographics2

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  • People aged 40 to 50 years
  • Accounts for 7% of all sports injuries
  • Male and females equally affected
  • 75% of patients are symptomatic in their dominant arm

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Signs and Symptoms

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  • Pain of insidious onset
  • Active movement may reproduce pain
  • Passive movement of full wrist flexion with pronation and elbow extension reproduces pain at the lateral epicondyle
  • Resistive isometric: resisted wrist extension and elbow extension reproduces pain at lateral epicondyle
  • Elbow-joint movements should be full and painless
  • Palpation tenderness at lateral epicondyle within musculature of extensor digitorum and extensor carpi radialis longus; rarely involves extensor carpi ulnaris or extensor carpi radialis brevis
  • Rubor and warmth may be present over lateral epicondyle or associated muscle belly
  • Pain and tenderness over the lateral epicondyle
  • Pain response varies between dull ache, no pain at rest, sharp pain with activities

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Functional Limitations

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  • Pain with pinching, squeezing, holding heavy objects, wringing
  • Pain with movements of the hand and wrist
  • Loss of strength
  • Difficulty with grasping activities

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Possible Contributing Causes

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  • Occupations requiring repetitive use of hands for excessive periods of time
  • Direct trauma to tendon or wrist
  • Sports or occupational activities
    • Tennis, golf, bowling, football, archery, weightlifting
    • Carpentry, plumbing, mechanic
  • Most commonly results from repetitive forearm, wrist, hand motions

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Differential Diagnosis

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  • Radial nerve entrapment
  • Bicipital tendonitis
  • Rheumatoid arthritis
  • Radiocapitellar arthritis
  • Posterior interosseous nerve compression (radial tunnel syndrome)
  • Osteochondritis dissecans of the capitellum
  • Carpal tunnel syndrome
  • Triceps tendonitis
  • Pronator syndrome
  • ...

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