The management of tennis elbow.

Tennis elbow is a tendinopathy of the common extensor origin (fig 1) of the lateral elbow. Although the pathology is in the elbow region, patients present with gradual onset of pain on extension movements of the wrist and fingers and supination of the forearm. The condition was formerly known as “lateral epicondylitis.” Because the pathology is no longer thought to be inflammatory, the “itis” suffix is a misnomer, 2 and it is more accurately described as a partially reversible but degenerative overuse-underuse tendinopathy. Because of the length of this term, most clinicians prefer to use the informal name “tennis elbow.” The condition is usually easy to diagnose on clinical presentation (imaging is rarely needed to exclude coexisting elbow joint pathology) but much harder to cure. The clinical features are tenderness at the lateral epicondyle, normal elbow range of motion, and pain on resisted movements (particularly resisted third finger extension). If the elbow’s range of motion is restricted, other diagnoses should be considered because the loss of range suggests joint pathology. The cause of the injury varies, but altered loading patterns are a common theme. Most patients don’t play tennis, but when the injury is caused by playing tennis it is the backhand stroke that leads to excessive loading of the tendons at the common extensor origin. Since racquet frames became lighter and coaches started teaching the double handed backhand stroke, tennis elbow has become less common in tennis players. Many tennis players have a weekly training and playing routine that regularly loads the tendons and keeps them healthy. More typically the injury occurs in people who have been sedentary for years and then begin exercising at the gym, start doing some gardening, paint a room, lift a new baby, or even just carry heavy luggage on holiday and overuse a previously underused and atrophied tendon. Tennis players, people who exercise regularly, and working tradespeople who regularly load the tendon are also at risk of injury if the load increases or they decrease rest periods between loads. What is the mechanism of injury?