Materiały źródłowe

• #1 Evaluation of Elbow Pain in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/0415/p649.html

  Injury to the UCL results in significant valgus elbow instability and may predispose an athlete to secondary injuries. […] The most important examination for a possible UCL injury is assessment of the medial joint space laxity or instability against valgus forces. […] This overuse tendinopathy occurs in approximately 1% to 3% of the population annually, and although it is commonly called tennis elbow, only 5% to 10% of tennis players develop the condition. […] The lateral epicondyle of humerus serves as the common extensor origin for the active supinators of the forearm, including the extensor carpi radialis brevis. […] Pain and decreased strength with resisted gripping and with wrist supination and extension are often present.

• #2 Tennis Elbow: Causes and Treatment

  https://patient.info/bones-joints-muscles/tendinopathy-and-tenosynovitis-tendinosis/tennis-elbow

  Tennis elbow is a condition where there is pain on the outer side of the elbow. It is often caused by overuse strain, causing damage to tendons around the elbow. […] The site of the pain in tennis elbow is where some tendons from the forearm muscles attach to the bone around the elbow. The pain is thought to be caused by swelling or thickening of the tendon initially and eventually degeneration (wearing) of the tendon. […] This damage is usually caused by overuse of the forearm muscles in repeated actions such as wringing clothes or manual work (particularly with twisting movements such as using a screwdriver). […] Playing tennis or other racquet sports can also cause tendon injuries. However, despite being called tennis elbow, racquet sports are only thought to be the cause in about 5 in 100 cases.

• #3 Lateral Epicondylitis (Tennis Elbow) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431092/

  Lateral epicondylitis, also commonly referred to as tennis elbow, describes an overuse injury that occurs secondary to an eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused by activities that involve loaded and repeated gripping and/or wrist extension. […] Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. […] This condition is primarily a degenerative overuse process of the extensor carpi radialis brevis and the common extensor tendon. Aside from degenerative changes, the histological findings include granulation tissue, micro-rupture, an abundance of fibroblasts, vascular hyperplasia, unstructured collagen, and a notable lack of traditional inflammatory cells (macrophages, lymphocytes, neutrophils) within the tissue. The term has been previously described as angiofibroblastic dysplasia based on multiple histologic studies describing its microscopic appearance and characteristics. […] Multiple studies reporting the histologic appearance of pathologic ECRB specimens characterize any combination of the following characteristics: Hypertrophic or abundant fibroblasts, Collagen disorganization, Vascular hyperplasia, Lack of inflammatory cells.

• #4 Tennis Elbow (Lateral Epicondylitis) – OrthoInfo – AAOS

  https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/

  Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. […] Tennis elbow involves the degeneration (wearing down) or, in some cases, microtearing of the tendons that join the forearm muscles on the outside of the elbow. […] Tennis elbow is often due to damage to a specific forearm muscle (ECRB). The ECRB muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB muscle is weakened from overuse, microscopic tears form in the ECRB tendon where it attaches to the lateral epicondyle. This leads to pain directly over the outside (lateral) part of the elbow. […] Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called idiopathic, or of an unknown cause.

• #5 Tennis Elbow – Definition, Anatomy and Causes – Town Center Orthopaedics

  https://www.towncenterortho.com/blog/tennis-elbow-definition-anatomy-and-causes/

  Tennis elbow arises when microscopic tears, degeneration and inflammation occur in or near some of these tendons. […] The basic cause of tennis elbow is a mismatch between what level of activity is asked of the elbow tendons and what they are in shape to do. […] Overuse of the tendon can occur through two basic mechanisms. The most common mechanism is that the level of activity is too great for the normal tendon.

• #6 Lateral Epicondylitis (Tennis Elbow) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431092/

  Lateral epicondylitis, also commonly referred to as tennis elbow, describes an overuse injury that occurs secondary to an eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused by activities that involve loaded and repeated gripping and/or wrist extension. […] Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. […] This condition is primarily a degenerative overuse process of the extensor carpi radialis brevis and the common extensor tendon. Aside from degenerative changes, the histological findings include granulation tissue, micro-rupture, an abundance of fibroblasts, vascular hyperplasia, unstructured collagen, and a notable lack of traditional inflammatory cells (macrophages, lymphocytes, neutrophils) within the tissue. The term has been previously described as angiofibroblastic dysplasia based on multiple histologic studies describing its microscopic appearance and characteristics. […] Multiple studies reporting the histologic appearance of pathologic ECRB specimens characterize any combination of the following characteristics: Hypertrophic or abundant fibroblasts, Collagen disorganization, Vascular hyperplasia, Lack of inflammatory cells.

• #7 Tennis elbow – Wikipedia

  https://en.wikipedia.org/wiki/Tennis_elbow

  Tennis elbow, also known as lateral epicondylitis, is an enthesopathy (attachment point disease) of the origin of the extensor carpi radialis brevis on the lateral epicondyle. It causes pain and tenderness over the bony part of the lateral epicondyle. Symptoms range from mild tenderness to severe, persistent pain. The pain may also extend into the back of the forearm. It usually has a gradual onset, but it can seem sudden and be misinterpreted as an injury. […] Tennis elbow is often idiopathic. Its cause and pathogenesis are unknown. It likely involves tendinosis, a degeneration of the local tendon. […] The exact cause of lateral epicondylitis remains unclear. However, it is often linked to repetitive microtrauma resulting from excessive gripping, wrist extension, radial deviation, and/or forearm supination.

• #8 Tennis Elbow: What It Is, Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/7049-tennis-elbow-lateral-epicondylitis

  Tennis elbow happens when you do a repetitive motion like twisting or swinging your lower arm a lot. Extra stress on your elbow damages the tendon that connects your forearm muscles to your elbow. […] Tennis elbow gets its name from being a common sports injury for people who play tennis or other racket sports. It happens when you overuse the tendon that connects your forearm muscles to your elbow (your extensor muscle tendon). […] The medical term for tennis elbow is lateral epicondylitis. Epicondylitis is inflammation in the extensor muscle tendon. Lateral epicondylitis means the inflammation is on the lateral side the outside edge when you hold your arms at your sides with your palms facing forward, the same direction as your eyes. […] Any motion or activity that you frequently repeat can trigger tennis elbow. Extra stress from repetitive movements builds up over time. Eventually, that added use and stress on your extensor muscle tendon causes tiny tears (microtraumas). Those microtraumas cause symptoms you can feel and notice.

• #9 Lateral Epicondylitis/Tennis Elbow – Englewood Orthopedic Associates

  https://englewoodortho.com/lateral-epicondylitis-tennis-elbow/

  This condition, commonly called tennis elbow, is an inflammation of the tendons that connect the muscles of the forearm to the elbow. The pain is primarily felt at the lateral epicondyle, the bony bump on the outer side of the elbow. […] Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. […] Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow. […] Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

• #10 Tennis Elbow – lateral epicondylalgia | Kingsley Physio | More than your local Physio

  https://kingsleyphysio.com/common-conditions/tennis-elbow-lateral-epicondylalgia/

  Because tennis elbow is frequently left untreated until several months (or years) after the onset of symptoms, it is not uncommon to see concurrent enthespoathic changes on MRI or even plain film x-rays (see Achilles tendontits and enthesitis for further information on enthesopathies). […] ImageInflammation and even small tears of the extensor carpi radialis brevis muscle as it attaches to the lateral epicondyle may be present on MRI. This obscure but influential muscle has a comparatively small area of attachment to the bone at its origin. It is speculated that because of this it is more vulnerable and more readily traumatised by ballistic, rapid contractions such as may be seen in racquet sports.

• #11 Lateral Epicondylitis/Tennis Elbow – Englewood Orthopedic Associates

  https://englewoodortho.com/lateral-epicondylitis-tennis-elbow/

  Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB). […] The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time. […] Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. […] Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “insidious” or of an unknown cause.

• #12 Lateral Epicondylitis (Tennis Elbow) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431092/

  Lateral epicondylitis, also commonly referred to as tennis elbow, describes an overuse injury that occurs secondary to an eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused by activities that involve loaded and repeated gripping and/or wrist extension. […] Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. […] This condition is primarily a degenerative overuse process of the extensor carpi radialis brevis and the common extensor tendon. Aside from degenerative changes, the histological findings include granulation tissue, micro-rupture, an abundance of fibroblasts, vascular hyperplasia, unstructured collagen, and a notable lack of traditional inflammatory cells (macrophages, lymphocytes, neutrophils) within the tissue. The term has been previously described as angiofibroblastic dysplasia based on multiple histologic studies describing its microscopic appearance and characteristics. […] Multiple studies reporting the histologic appearance of pathologic ECRB specimens characterize any combination of the following characteristics: Hypertrophic or abundant fibroblasts, Collagen disorganization, Vascular hyperplasia, Lack of inflammatory cells.

• #13 Tennis elbow – Wikipedia

  https://en.wikipedia.org/wiki/Tennis_elbow

  Lateral epicondylitis was initially considered an inflammatory process, however there is no evidence of inflammation or repair. Therefore, the disorder is more appropriately referred to as tendinosis or tendinopathy. Tendinosis, a degenerative condition with fibroblasts, abnormal collagen, and increased blood vessels. Repetitive stress causes microtears, scar tissue formation, and biomechanical changes, worsening symptoms over time. […] The conclusion reached is that the pathophysiology of tennis elbow is due to an initial microscopic tear from a sprain/strain. This initial injury is aggravated at night by pressure on the sprain which delays healing. In other words, tennis elbow is neither a tendonitis nor a tendinosis, but more like a pressure sore. If the pressure is removed the initial injury goes on to heal.

• #14 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #15 Lateral Epicondylitis / Tennis Elbow | The Bone School

  http://www.boneschool.com/upper-limb/elbow/epicondylitis/lateral-epicondylitis-tennis-elbow

  Starts as micro-tear in ECRB […] Get high grade partial tear […] Angiofibrotic hyperplasia […] marked fibroblast proliferation […] extensive vascular hyperplasia […] disorganised collagen production […] may go on to dystrophic calcification […] Disruption of parallel orientation of collagen fibres […] invasion of fibroblasts and vascular granulation type tissue […] without an acute or chronic inflammatory component.

• #16 Lateral Epicondylitis (Tennis Elbow): Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/96969-overview

  Lateral epicondylitis (commonly referred to as tennis elbow) is related to excessive wrist extension. […] The most common overuse syndrome is related to excessive wrist extension and commonly referred to as tennis elbow, but it is actually more common in non-tennis players. […] Microscopic evaluation of the tendons does not show signs of inflammation, but rather angiofibroblastic degeneration and collagen disarray. […] The tendons are relatively hypovascular proximal to the tendon insertion. This hypovascularity may predispose the tendon to hypoxic tendon degeneration and has been implicated in the etiology of tendinopathies. […] Most typically, the primary pathology is tendinosis of the extensor carpi radialis brevis (ECRB) tendon 1-2 cm distal to its attachment on the lateral epicondyle. […] The causes of lateral epicondylitis include poor general conditioning, improper training, improper technique, poor or improper equipment, and scapular dyskinesis.

• #17 Lateral Epicondylitis (Tennis Elbow) – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK431092/

  Lateral epicondylitis, also commonly referred to as tennis elbow, describes an overuse injury that occurs secondary to an eccentric overload of the common extensor tendon at the origin of the extensor carpi radialis brevis (ECRB) tendon. Tennis elbow primarily results from the repetitive strain caused by activities that involve loaded and repeated gripping and/or wrist extension. […] Tennis elbow is often an overuse injury primarily due to repetitive strain from tasks and activities that involve loaded and repeated gripping and/or wrist extension. It historically occurs in tennis players but can result from any sports that require repetitive wrist extension, radial deviation, and/or forearm supination. […] This condition is primarily a degenerative overuse process of the extensor carpi radialis brevis and the common extensor tendon. Aside from degenerative changes, the histological findings include granulation tissue, micro-rupture, an abundance of fibroblasts, vascular hyperplasia, unstructured collagen, and a notable lack of traditional inflammatory cells (macrophages, lymphocytes, neutrophils) within the tissue. The term has been previously described as angiofibroblastic dysplasia based on multiple histologic studies describing its microscopic appearance and characteristics. […] Multiple studies reporting the histologic appearance of pathologic ECRB specimens characterize any combination of the following characteristics: Hypertrophic or abundant fibroblasts, Collagen disorganization, Vascular hyperplasia, Lack of inflammatory cells.

• #18

  https://www.orthobullets.com/shoulder-and-elbow/3082/lateral-epicondylitis-tennis-elbow

  Lateral Epicondylitis (also known as Tennis Elbow) is an overuse injury caused by eccentric overload at the origin of the common extensor tendon, leading to tendinosis and inflammation of the ECRB. […] mechanism […] tenodesis effect to optimize grip causes overuse of ECRB. […] precipitated by repetitive wrist extension and forearm pronation. […] thought to begin as a microtear of the origin of ECRB. […] may also involve microtears of ECRL and ECU. […] a degenerative process as opposed to an inflammatory process. […] microscopic evaluation of the tissue reveals […] disorganized collagen. […] lacks inflammatory cells. […] histopathological studies of the ECRB tendon tissue shows […] No inflammatory changes.

• #19 Lateral Epicondylitis / Tennis Elbow | The Bone School

  http://www.boneschool.com/upper-limb/elbow/epicondylitis/lateral-epicondylitis-tennis-elbow

  Starts as micro-tear in ECRB […] Get high grade partial tear […] Angiofibrotic hyperplasia […] marked fibroblast proliferation […] extensive vascular hyperplasia […] disorganised collagen production […] may go on to dystrophic calcification […] Disruption of parallel orientation of collagen fibres […] invasion of fibroblasts and vascular granulation type tissue […] without an acute or chronic inflammatory component.

• #20 Lateral epicondylitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/lateral-epicondylitis?lang=us

  Lateral epicondylitis, also known as tennis elbow, is an overuse syndrome of the common extensor tendon and predominantly affects the extensor carpi radialis brevis (ECRB) tendon. […] It is thought that repetitive stress and overuse will lead to tendinosis involving the origin of the extensor tendons at the lateral elbow, with micro-tearing and progressive degeneration due to an immature reparative response that may progress to a full-thickness tendon tear. […] Histology demonstrates tendinosis, enthesopathy, disorganization of collagen architecture, mucoid change, fibrosis and variable vascular proliferation.

• #21 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Lateral Epicondylitis (Tennis Elbow): Pathogenesis and clinical findings […] Extrinsic Factors: activities involving repeated forceful use of the extensor-supinator muscle groups (sports including tennis and squash, activities such as painting, carpentry or using certain hand tools) […] Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion […] Micro-tears within extensor-supinator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide) […] Continued repetitive strains with inadequate recovery time between activities healing unable to meet tissue damage […] Ineffective revascularization of damaged tissue […] Disorganized collagen formation and scarring type III

• #22 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Nerve growth within damaged tissue collagen (most common collagen involved with wound healing) (consequence of healing response) […] Tendon thickening […] Decreased tensile strength of tendon […] Weakness of the extensor- supinator muscle groups […] Lateral Epicondylitis Tendinosis at the common extensor-supinator origin at the lateral epicondyle of the humerus […] Local nerves are compressed by thickened tendon nociceptors within tendon are activated […] Pain with passive wrist […] Pain localized to flexion or resisted extension lateral epicondyle […] Tenderness over the proximal wrist extensor-supinator muscles […] Severity ranges from mild to severe based on the effect on patient activities […] Mild tendinopathy: patient continues […] Moderate tendinopathy: patient continues […] Severe tendinopathy: patients daily most activities with minor pain some activities with modifications activities are impacted by severe pain.

• #23 Elbow Tendinosis | Nirschl Orthopaedic Center

  https://www.nirschl.com/elbow-tendinosis/

  Kraushaar and Nirschl, in their review of tennis elbow, described chronic overuse injuries resulting from multiple microtraumatic events that accumulate to disrupt the internal structure of the tendon and lead to degeneration of the cells and cellular matrix. […] Nirschl has called this degenerative process a tendinosis, indicative of the failed intrinsic mechanism of the tendon to heal, rather than a tendinitis. […] A tendinitis implies an extrinsic blood borne response including the presence of inflammatory cells not evident in the histopathological studies of chronic overuse tendons. […] Nirschl and Petrone described these histopathological changes as angiofibroblastic tendinosis, a distinctly non-inflammatory, degenerative, avascular process involving the formation of immature and disorganized collagen with immature fibroblastic and vascular elements.

• #24 Impact of lifestyle and clinical factors on the prognosis of tennis elbow | Scientific Reports

  https://www.nature.com/articles/s41598-024-53669-x

  Two main theories exist regarding the pathogenesis of tennis elbow: tendon degeneration theory and inflammatory mediator theory. The tendon degeneration theory posits that tendon damage results from overuse, leading to collagen degeneration, microcirculation disturbance, and fibroblast proliferation independent of the presence of inflammatory mediators. In contrast, the inflammatory mediator theory suggests that overuse of the tendon leads to the release of inflammatory mediators, driving tendon degeneration and playing a pivotal role in the pathological process of the disease. […] Our study demonstrates that smoking substantially negatively influences patients recovery from lateral epicondylitis. Smokers in this study had a 4.2-fold higher risk of undergoing surgery than nonsmokers, this indicates the dangers of smoking.

• #25 Impact of lifestyle and clinical factors on the prognosis of tennis elbow | Scientific Reports

  https://www.nature.com/articles/s41598-024-53669-x

  Two main theories exist regarding the pathogenesis of tennis elbow: tendon degeneration theory and inflammatory mediator theory. The tendon degeneration theory posits that tendon damage results from overuse, leading to collagen degeneration, microcirculation disturbance, and fibroblast proliferation independent of the presence of inflammatory mediators. In contrast, the inflammatory mediator theory suggests that overuse of the tendon leads to the release of inflammatory mediators, driving tendon degeneration and playing a pivotal role in the pathological process of the disease. […] Our study demonstrates that smoking substantially negatively influences patients recovery from lateral epicondylitis. Smokers in this study had a 4.2-fold higher risk of undergoing surgery than nonsmokers, this indicates the dangers of smoking.

• #26 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Lateral Epicondylitis (Tennis Elbow): Pathogenesis and clinical findings […] Extrinsic Factors: activities involving repeated forceful use of the extensor-supinator muscle groups (sports including tennis and squash, activities such as painting, carpentry or using certain hand tools) […] Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion […] Micro-tears within extensor-supinator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide) […] Continued repetitive strains with inadequate recovery time between activities healing unable to meet tissue damage […] Ineffective revascularization of damaged tissue […] Disorganized collagen formation and scarring type III

• #27 Impact of lifestyle and clinical factors on the prognosis of tennis elbow | Scientific Reports

  https://www.nature.com/articles/s41598-024-53669-x

  Two main theories exist regarding the pathogenesis of tennis elbow: tendon degeneration theory and inflammatory mediator theory. The tendon degeneration theory posits that tendon damage results from overuse, leading to collagen degeneration, microcirculation disturbance, and fibroblast proliferation independent of the presence of inflammatory mediators. In contrast, the inflammatory mediator theory suggests that overuse of the tendon leads to the release of inflammatory mediators, driving tendon degeneration and playing a pivotal role in the pathological process of the disease. […] Our study demonstrates that smoking substantially negatively influences patients recovery from lateral epicondylitis. Smokers in this study had a 4.2-fold higher risk of undergoing surgery than nonsmokers, this indicates the dangers of smoking.

• #28 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  On a more technical level, substance P and calcitonin gene-related peptide reactive nerve fibres have been located in the proximal ECRB tendon in conjunction with small blood vessels. […] In regards to pathophysiology, remember that LE is a multidimensional condition that involves three main components consisting of the affected muscles, the tendon itself, and the local and central pain processing system.

• #29 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #30 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Nerve growth within damaged tissue collagen (most common collagen involved with wound healing) (consequence of healing response) […] Tendon thickening […] Decreased tensile strength of tendon […] Weakness of the extensor- supinator muscle groups […] Lateral Epicondylitis Tendinosis at the common extensor-supinator origin at the lateral epicondyle of the humerus […] Local nerves are compressed by thickened tendon nociceptors within tendon are activated […] Pain with passive wrist […] Pain localized to flexion or resisted extension lateral epicondyle […] Tenderness over the proximal wrist extensor-supinator muscles […] Severity ranges from mild to severe based on the effect on patient activities […] Mild tendinopathy: patient continues […] Moderate tendinopathy: patient continues […] Severe tendinopathy: patients daily most activities with minor pain some activities with modifications activities are impacted by severe pain.

• #31 The Controversial Pain Syndrome of Tennis Elbow (TE): Pathogenesis and Surgical Treatment of Resistant Cases | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-54513-9_1

  As of today, aetiology and pathogenesis of TE are still unsolved; despite Winkworths statement in 1883, already, the disease can be led back to a pressure damage of the radial nerve deep branch at the supinator muscle, where the nerve is compressed by diverse actions of muscle fibers. […] Nevertheless even seven recent reviews since 2003 hold the opinion TE is based on a degenerative process at the ECRB origin, mentioning the neurogenous pathogenesis, but only discussing it insufficiently. […] Authors agree with positive results of diverse procedures at the extensor tendon apparatus, whereas the pathogenesis of the TE is not understood. […] Kay (J Hand Surg 28B: 460464, 2003) even states that pathogenesis is a mystery. […] This mystery could have been solved earlier, if innervation of the main pain area at the elbow had been taken into account

• #32 Biomechanics of the elbow joint in tennis players and relation to pathology | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/41/11/820

  Elbow injuries constitute a sizeable percentage of tennis injuries. A basic understanding of biomechanics of tennis and analysis of the forces, loads and motions of the elbow during tennis will improve the understanding of the pathophysiology of these injuries. […] The magnitude of forces across the elbow during tennis strokes can produce tremendous valgus and extension overload in players. […] Biomechanical analysis of these forces, loads and motion on the elbow in tennis will lead to an improved understanding of the pathophysiology of injuries in tennis. […] This combination of valgus forces and rapid extension during tennis results in tensile forces along the medial side, compression on the lateral portion of the elbow and shear forces in the posterior compartment. This combination is often called valgus extension overload syndrome in overhead athletes and can play a role in some injuries in the elbow in tennis players.

• #33 Biomechanics of the elbow joint in tennis players and relation to pathology | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/41/11/820

  Elbow injuries constitute a sizeable percentage of tennis injuries. A basic understanding of biomechanics of tennis and analysis of the forces, loads and motions of the elbow during tennis will improve the understanding of the pathophysiology of these injuries. […] The magnitude of forces across the elbow during tennis strokes can produce tremendous valgus and extension overload in players. […] Biomechanical analysis of these forces, loads and motion on the elbow in tennis will lead to an improved understanding of the pathophysiology of injuries in tennis. […] This combination of valgus forces and rapid extension during tennis results in tensile forces along the medial side, compression on the lateral portion of the elbow and shear forces in the posterior compartment. This combination is often called valgus extension overload syndrome in overhead athletes and can play a role in some injuries in the elbow in tennis players.

• #34 Biomechanics of the elbow joint in tennis players and relation to pathology | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/41/11/820

  Elbow injuries constitute a sizeable percentage of tennis injuries. A basic understanding of biomechanics of tennis and analysis of the forces, loads and motions of the elbow during tennis will improve the understanding of the pathophysiology of these injuries. […] The magnitude of forces across the elbow during tennis strokes can produce tremendous valgus and extension overload in players. […] Biomechanical analysis of these forces, loads and motion on the elbow in tennis will lead to an improved understanding of the pathophysiology of injuries in tennis. […] This combination of valgus forces and rapid extension during tennis results in tensile forces along the medial side, compression on the lateral portion of the elbow and shear forces in the posterior compartment. This combination is often called valgus extension overload syndrome in overhead athletes and can play a role in some injuries in the elbow in tennis players.

• #35 Biomechanics of the elbow joint in tennis players and relation to pathology | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/41/11/820

  The previous described valgus and internal rotatory forces result in microtrauma of the UCL and eventually attenuation of the ligament. […] Attenuation of UCL leads to abnormal valgus movement of the elbow joint affecting the mechanics of the highly constrained articulation of the posterior elbow. […] In prevention and treatment of UCL insufficiency in tennis players, therapy should be based on the above-mentioned biomechanics overload in all three planes of movement, extension, rotation and valgus. […] Unlike to the common tennis elbow, or lateral epicondylitis, this tendinosis is more common in high-level tennis players than it is in recreational players. […] The unusual EMG findings of increased activity in injured muscles can be explained by faulty mechanics that predispose to the development of tennis elbow. […] Tennis places the ligamentous, osseous, musculotendinous and neural structures of the elbow at increased risk for various injuries. Proper training and preventive exercise, based on sound biomechanical research, can result in decrease of loads across the elbow in tennis players.

• #36 Biomechanics of the elbow joint in tennis players and relation to pathology | British Journal of Sports Medicine

  https://bjsm.bmj.com/content/41/11/820

  The previous described valgus and internal rotatory forces result in microtrauma of the UCL and eventually attenuation of the ligament. […] Attenuation of UCL leads to abnormal valgus movement of the elbow joint affecting the mechanics of the highly constrained articulation of the posterior elbow. […] In prevention and treatment of UCL insufficiency in tennis players, therapy should be based on the above-mentioned biomechanics overload in all three planes of movement, extension, rotation and valgus. […] Unlike to the common tennis elbow, or lateral epicondylitis, this tendinosis is more common in high-level tennis players than it is in recreational players. […] The unusual EMG findings of increased activity in injured muscles can be explained by faulty mechanics that predispose to the development of tennis elbow. […] Tennis places the ligamentous, osseous, musculotendinous and neural structures of the elbow at increased risk for various injuries. Proper training and preventive exercise, based on sound biomechanical research, can result in decrease of loads across the elbow in tennis players.

• #37 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Lateral Epicondylitis (Tennis Elbow): Pathogenesis and clinical findings […] Extrinsic Factors: activities involving repeated forceful use of the extensor-supinator muscle groups (sports including tennis and squash, activities such as painting, carpentry or using certain hand tools) […] Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion […] Micro-tears within extensor-supinator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide) […] Continued repetitive strains with inadequate recovery time between activities healing unable to meet tissue damage […] Ineffective revascularization of damaged tissue […] Disorganized collagen formation and scarring type III

• #38 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Lateral Epicondylitis (Tennis Elbow): Pathogenesis and clinical findings […] Extrinsic Factors: activities involving repeated forceful use of the extensor-supinator muscle groups (sports including tennis and squash, activities such as painting, carpentry or using certain hand tools) […] Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion […] Micro-tears within extensor-supinator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide) […] Continued repetitive strains with inadequate recovery time between activities healing unable to meet tissue damage […] Ineffective revascularization of damaged tissue […] Disorganized collagen formation and scarring type III

• #39 Tennis elbow

  https://pathologies.lexmedicus.com.au/collection/tennis-elbow-lateral-epicondylitis

  Tennis elbow is mostly due to repetitive use of those movements that are commonly executed in playing tennis. It has an incidence of 50% in tennis players and occurs more frequently in individuals between 40-50 years of age. Lateral epicondylitis can also develop in other activities involving the frequent use of the elbows and wrists such as labourers (plumbers, painters, gardeners and carpenters) and computer users due to improper use of the keyboard. […] A number of recreational sports and professions performing rigorous daily activities may increase the risk of acquiring tennis elbow such as: Racquet sports, Throwing sports, Muscle weakness, Poor flexibility of the forearm, Training errors, Improper technique, Wrong equipment, Occupations involving repetitive wrist extension (carpenters, bricklayers, tailors, pianists, drummers, computer users, typists).

• #40 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Lateral Epicondylitis (Tennis Elbow): Pathogenesis and clinical findings […] Extrinsic Factors: activities involving repeated forceful use of the extensor-supinator muscle groups (sports including tennis and squash, activities such as painting, carpentry or using certain hand tools) […] Intrinsic Factors: age, body weight, nutrition, gender, anatomical variations, joint laxity, systemic disease, muscle weakness / imbalance, vascular perfusion […] Micro-tears within extensor-supinator tendons initiating healing process: inflammation, proliferation, and remodeling (see acute wound healing slide) […] Continued repetitive strains with inadequate recovery time between activities healing unable to meet tissue damage […] Ineffective revascularization of damaged tissue […] Disorganized collagen formation and scarring type III

• #41 Tennis Elbow Pathogenesis | Seijas | International Journal of Orthopaedics

  http://www.ghrnet.org/index.php/ijo/article/view/1988/0

  Lateral epicondylitis, also known as tennis elbow, is a common pathology that usually affects tennis players and athletes involved in overhead throwing, especially athletes between 30 and 50 years old. […] This pathology is related to a repetitive contraction of the extensor carpi radialis and it could also be associated with the conditions of the tennis racquet, an improper technique while playing tennis or with the frequency of play. […] The aim of this review is to analyze the different causes of suffering lateral epicondylitis in tennis players and its pathogenesis.

• #42 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Tennis-Elbow.aspx

  Tennis elbow (or lateral epicondylitis) is the most common cause of lateral elbow pain among men and women aged 30 to 50 years and arises from the repetitive stress on or the overuse (continued pronation, supination, extension, and flexion) of the forearm muscles. Overuse could lead to the formation of microscopic tears or microtears in the tendon at the point where it attaches to the bone and swelling of the tendons that bend the wrist backward away from the palm leading to pain and difficulty in movement of the affected muscle. The basic pathology of tennis elbow involves an imbalance between the forearm muscle strength and the load put on the forearm muscles. The symptoms of tennis elbow are thought to develop due to the degeneration of chronically injured tendon fibers with micro-tears leading to inflammation and pain near the bony lump (lateral epicondyle) on the lateral aspect of the elbow joint. Factors that predispose to the muscular imbalance include (i) weak forearm and shoulder muscles, (ii) stiffness of the forearm or the elbow joint, (iii) unstable elbow joint, (iv) positioning the hand and arm in non-neutral positions for prolonged periods, (v) excessive loading of the elbow joint during sports activities by the use of incorrect techniques and/or incorrectly-sized equipment, or overuse during sports activities such as tennis, and (vi) excessive loading on the joint due to the use of heavy hand-held equipment, too tightly strung or too short racquets, or too heavy or wet balls. Tennis elbow results in pain and tenderness in the lateral aspect of the elbow joint as a result of chronic degeneration of elbow tendon fibers and microtear formation. […] However, it is a self-limiting condition, the symptoms of which can improve by several treatments such as medications, physiotherapy, injections, ice applications, shock wave therapy, and surgery.

• #43 Lateral Epicondylitis/Tennis Elbow – Englewood Orthopedic Associates

  https://englewoodortho.com/lateral-epicondylitis-tennis-elbow/

  Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB). […] The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time. […] Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. […] Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “insidious” or of an unknown cause.

• #44 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Tennis-Elbow.aspx

  Tennis elbow (or lateral epicondylitis) is the most common cause of lateral elbow pain among men and women aged 30 to 50 years and arises from the repetitive stress on or the overuse (continued pronation, supination, extension, and flexion) of the forearm muscles. Overuse could lead to the formation of microscopic tears or microtears in the tendon at the point where it attaches to the bone and swelling of the tendons that bend the wrist backward away from the palm leading to pain and difficulty in movement of the affected muscle. The basic pathology of tennis elbow involves an imbalance between the forearm muscle strength and the load put on the forearm muscles. The symptoms of tennis elbow are thought to develop due to the degeneration of chronically injured tendon fibers with micro-tears leading to inflammation and pain near the bony lump (lateral epicondyle) on the lateral aspect of the elbow joint. Factors that predispose to the muscular imbalance include (i) weak forearm and shoulder muscles, (ii) stiffness of the forearm or the elbow joint, (iii) unstable elbow joint, (iv) positioning the hand and arm in non-neutral positions for prolonged periods, (v) excessive loading of the elbow joint during sports activities by the use of incorrect techniques and/or incorrectly-sized equipment, or overuse during sports activities such as tennis, and (vi) excessive loading on the joint due to the use of heavy hand-held equipment, too tightly strung or too short racquets, or too heavy or wet balls. Tennis elbow results in pain and tenderness in the lateral aspect of the elbow joint as a result of chronic degeneration of elbow tendon fibers and microtear formation. […] However, it is a self-limiting condition, the symptoms of which can improve by several treatments such as medications, physiotherapy, injections, ice applications, shock wave therapy, and surgery.

• #45 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Tennis-Elbow.aspx

  Tennis elbow (or lateral epicondylitis) is the most common cause of lateral elbow pain among men and women aged 30 to 50 years and arises from the repetitive stress on or the overuse (continued pronation, supination, extension, and flexion) of the forearm muscles. Overuse could lead to the formation of microscopic tears or microtears in the tendon at the point where it attaches to the bone and swelling of the tendons that bend the wrist backward away from the palm leading to pain and difficulty in movement of the affected muscle. The basic pathology of tennis elbow involves an imbalance between the forearm muscle strength and the load put on the forearm muscles. The symptoms of tennis elbow are thought to develop due to the degeneration of chronically injured tendon fibers with micro-tears leading to inflammation and pain near the bony lump (lateral epicondyle) on the lateral aspect of the elbow joint. Factors that predispose to the muscular imbalance include (i) weak forearm and shoulder muscles, (ii) stiffness of the forearm or the elbow joint, (iii) unstable elbow joint, (iv) positioning the hand and arm in non-neutral positions for prolonged periods, (v) excessive loading of the elbow joint during sports activities by the use of incorrect techniques and/or incorrectly-sized equipment, or overuse during sports activities such as tennis, and (vi) excessive loading on the joint due to the use of heavy hand-held equipment, too tightly strung or too short racquets, or too heavy or wet balls. Tennis elbow results in pain and tenderness in the lateral aspect of the elbow joint as a result of chronic degeneration of elbow tendon fibers and microtear formation. […] However, it is a self-limiting condition, the symptoms of which can improve by several treatments such as medications, physiotherapy, injections, ice applications, shock wave therapy, and surgery.

• #46 Azthena logo with the word Azthena

  https://www.news-medical.net/health/What-Causes-Tennis-Elbow.aspx

  Tennis elbow (or lateral epicondylitis) is the most common cause of lateral elbow pain among men and women aged 30 to 50 years and arises from the repetitive stress on or the overuse (continued pronation, supination, extension, and flexion) of the forearm muscles. Overuse could lead to the formation of microscopic tears or microtears in the tendon at the point where it attaches to the bone and swelling of the tendons that bend the wrist backward away from the palm leading to pain and difficulty in movement of the affected muscle. The basic pathology of tennis elbow involves an imbalance between the forearm muscle strength and the load put on the forearm muscles. The symptoms of tennis elbow are thought to develop due to the degeneration of chronically injured tendon fibers with micro-tears leading to inflammation and pain near the bony lump (lateral epicondyle) on the lateral aspect of the elbow joint. Factors that predispose to the muscular imbalance include (i) weak forearm and shoulder muscles, (ii) stiffness of the forearm or the elbow joint, (iii) unstable elbow joint, (iv) positioning the hand and arm in non-neutral positions for prolonged periods, (v) excessive loading of the elbow joint during sports activities by the use of incorrect techniques and/or incorrectly-sized equipment, or overuse during sports activities such as tennis, and (vi) excessive loading on the joint due to the use of heavy hand-held equipment, too tightly strung or too short racquets, or too heavy or wet balls. Tennis elbow results in pain and tenderness in the lateral aspect of the elbow joint as a result of chronic degeneration of elbow tendon fibers and microtear formation. […] However, it is a self-limiting condition, the symptoms of which can improve by several treatments such as medications, physiotherapy, injections, ice applications, shock wave therapy, and surgery.

• #47 Lateral Epicondylitis (Tennis Elbow): Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/96969-overview

  Lateral epicondylitis (commonly referred to as tennis elbow) is related to excessive wrist extension. […] The most common overuse syndrome is related to excessive wrist extension and commonly referred to as tennis elbow, but it is actually more common in non-tennis players. […] Microscopic evaluation of the tendons does not show signs of inflammation, but rather angiofibroblastic degeneration and collagen disarray. […] The tendons are relatively hypovascular proximal to the tendon insertion. This hypovascularity may predispose the tendon to hypoxic tendon degeneration and has been implicated in the etiology of tendinopathies. […] Most typically, the primary pathology is tendinosis of the extensor carpi radialis brevis (ECRB) tendon 1-2 cm distal to its attachment on the lateral epicondyle. […] The causes of lateral epicondylitis include poor general conditioning, improper training, improper technique, poor or improper equipment, and scapular dyskinesis.

• #48 Pathophysiology of Tendinopathy: Implications for Tennis Elbow | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-71498-1_18

  Targeted therapies of elbow tendinopathies have been limited due to lack of knowledge of the underlying pathophysiology. […] Repetitive loading in combination with newly discovered intrinsic risk factors, such as genetic abnormalities of eg. matrix proteins and metabolic disorders lead to neuronal dysregulation and the development of tendinopathy. […] Aberrant sensory nerve sprouting in the tendon may cause pain and by constant release of mediators produce fibrosis.

• #49 Impact of lifestyle and clinical factors on the prognosis of tennis elbow | Scientific Reports

  https://www.nature.com/articles/s41598-024-53669-x

  Our research reveals that alcohol consumption is an independent risk factor for poor treatment outcomes in patients with lateral epicondylitis. Particularly, heavy drinkers are 3.74 times more likely to require surgery within 1 year than occasional drinkers. We speculate that alcohol-induced inflammatory reactions contribute to disease progression. […] Our results suggest that, compared with oral NSAIDs alone, combined treatment with oral NSAIDs and local corticosteroid injections can reduce the likelihood of requiring surgical treatment. Inflammatory changes are often absent in the early stage of lateral epicondylitis. We speculate that patients with middle to late-stage tennis elbow exhibit inflammatory changes, and inflammatory diseases respond well to corticosteroid treatment.

• #50 Traditional, Conservative Treatments for Tennis Elbow | HSS

  https://www.hss.edu/conditions_tennis-elbow-overview.asp

  Tennis elbow (lateral epicondylitis) is a form of tendonitis an overuse injury. It develops in one of the tendons that connects the muscles of the forearm to the humerus (upper arm bone) at the lateral epicondyle (a knobby portion of bone where the extensor muscles of the elbow originate). Over time, strain on the tendon gradually pulls it away from the bone, causing microscopic tears. […] The primary symptom of tennis elbow is pain. However, the mechanism that causes the pain is not well-understood. […] As with the mechanism that causes pain, the mechanism for pain relief provided by these injections is unclear particularly in the absence of a significant number of inflammatory cells. […] Two surgical techniques are available open surgery and elbow arthroscopy. Open surgery requires a larger incision and affords a number of options. A little chip of bone can be removed, which may increase blood flow to the area and therefore promote healing and reduce pain. Alternatively, a small portion of the tendon can be released by severing its connection to the bone. This reduces pain but leaves most of the tendon still attached to the bone and functional so that there is virtually no loss of mechanical strength.

• #51 Functional and Pain Improvement in Tennis Elbow with Dry Needling as Alternative Treatment: Case Series – touchNEUROLOGY

  https://touchneurology.com/neuropathic-pain/journal-articles/functional-and-pain-improvement-in-tennis-elbow-with-dry-needling-as-alternative-treatment-case-series/

  However, the cause of degenerative changes and pain is unclear. Mechanical, neural and vascular problems, and failure of healing are presumed to contribute to the pathophysiology of this condition. […] Although the exact mechanism of dry needling is not yet clear, this technique essentially decreases peripheral and central sensitization, which certainly influences tendon healing due to increased blood flow through local vasodilation and collagen proliferation. […] One review stated that periosteal stimulation can cause microtrauma, trigger local inflammation, improve fibroblastic repair processes, increase concentration and reorganization of collagen tissue, and mediate the proliferative and remodelling phases.

• #52 Functional and Pain Improvement in Tennis Elbow with Dry Needling as Alternative Treatment: Case Series – touchNEUROLOGY

  https://touchneurology.com/neuropathic-pain/journal-articles/functional-and-pain-improvement-in-tennis-elbow-with-dry-needling-as-alternative-treatment-case-series/

  Lateral epicondylitis, or tennis elbow, is pain in the lateral elbow as a result of repetitive forearm pronation and supination in elbow extension. […] Recently, it has become clear that lateral epicondylitis is a degenerative disorder that compromises the extensor tendons, originating from the lateral epicondyle, extending infrequently to the joint. […] Even though the terms epicondylitis and tendinitis are used to describe tennis elbow, histopathological studies, like those of Nirschl, characterize this condition rather as a form of tendinosis with a fibroblastic and vascular response, named angiofibroblastic degeneration of epicondylitis. […] The pathophysiology of lateral epicondylitis is still being debated. New studies show that the main pathophysiological features of tendinopathy are neovascularity and irregular collagen fibres.

• #53 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  On a more technical level, substance P and calcitonin gene-related peptide reactive nerve fibres have been located in the proximal ECRB tendon in conjunction with small blood vessels. […] In regards to pathophysiology, remember that LE is a multidimensional condition that involves three main components consisting of the affected muscles, the tendon itself, and the local and central pain processing system.

• #54 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Nerve growth within damaged tissue collagen (most common collagen involved with wound healing) (consequence of healing response) […] Tendon thickening […] Decreased tensile strength of tendon […] Weakness of the extensor- supinator muscle groups […] Lateral Epicondylitis Tendinosis at the common extensor-supinator origin at the lateral epicondyle of the humerus […] Local nerves are compressed by thickened tendon nociceptors within tendon are activated […] Pain with passive wrist […] Pain localized to flexion or resisted extension lateral epicondyle […] Tenderness over the proximal wrist extensor-supinator muscles […] Severity ranges from mild to severe based on the effect on patient activities […] Mild tendinopathy: patient continues […] Moderate tendinopathy: patient continues […] Severe tendinopathy: patients daily most activities with minor pain some activities with modifications activities are impacted by severe pain.

• #55 lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings | Calgary Guide

  https://calgaryguide.ucalgary.ca/lateral-epicondylitis-tennis-elbow-pathogenesis-and-clinical-findings/lateral-epicondylitis/

  Nerve growth within damaged tissue collagen (most common collagen involved with wound healing) (consequence of healing response) […] Tendon thickening […] Decreased tensile strength of tendon […] Weakness of the extensor- supinator muscle groups […] Lateral Epicondylitis Tendinosis at the common extensor-supinator origin at the lateral epicondyle of the humerus […] Local nerves are compressed by thickened tendon nociceptors within tendon are activated […] Pain with passive wrist […] Pain localized to flexion or resisted extension lateral epicondyle […] Tenderness over the proximal wrist extensor-supinator muscles […] Severity ranges from mild to severe based on the effect on patient activities […] Mild tendinopathy: patient continues […] Moderate tendinopathy: patient continues […] Severe tendinopathy: patients daily most activities with minor pain some activities with modifications activities are impacted by severe pain.

• #56 Pathophysiology of Tendinopathy: Implications for Tennis Elbow | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-319-71498-1_18

  Targeted therapies of elbow tendinopathies have been limited due to lack of knowledge of the underlying pathophysiology. […] Repetitive loading in combination with newly discovered intrinsic risk factors, such as genetic abnormalities of eg. matrix proteins and metabolic disorders lead to neuronal dysregulation and the development of tendinopathy. […] Aberrant sensory nerve sprouting in the tendon may cause pain and by constant release of mediators produce fibrosis.

• #57 Understanding the effects of tennis elbow – Personnel Today

  https://www.personneltoday.com/hr/understanding-the-effects-of-tennis-elbow/

  Local tendon pathology may result from overuse, tensile, compressive or shear forces, leaving the tendon in a debilitated state. Ultrasound imaging has identified structural changes associated with LE, including tendon thickening, thinning and tears. […] The pain gate theory of Melzack and Wall suggests a mechanism in the brain acting as a gate increasing or decreasing the flow of nerve impulses from the peripheral fibres to the central nervous system (CNS). This open gate allows the flow of nerve impulses, enabling the brain to perceive pain. […] There is evidence of dysfunction of the motor system in LE, including diminished strength, morphological changes and altered motor control. This explains the difficulty that Zara experienced when gripping and controlling objects, including the computer mouse and opening doors, which affected her day-to-day activities.

• #58 Understanding the effects of tennis elbow – Personnel Today

  https://www.personneltoday.com/hr/understanding-the-effects-of-tennis-elbow/

  Local tendon pathology may result from overuse, tensile, compressive or shear forces, leaving the tendon in a debilitated state. Ultrasound imaging has identified structural changes associated with LE, including tendon thickening, thinning and tears. […] The pain gate theory of Melzack and Wall suggests a mechanism in the brain acting as a gate increasing or decreasing the flow of nerve impulses from the peripheral fibres to the central nervous system (CNS). This open gate allows the flow of nerve impulses, enabling the brain to perceive pain. […] There is evidence of dysfunction of the motor system in LE, including diminished strength, morphological changes and altered motor control. This explains the difficulty that Zara experienced when gripping and controlling objects, including the computer mouse and opening doors, which affected her day-to-day activities.

• #59 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  On a more technical level, substance P and calcitonin gene-related peptide reactive nerve fibres have been located in the proximal ECRB tendon in conjunction with small blood vessels. […] In regards to pathophysiology, remember that LE is a multidimensional condition that involves three main components consisting of the affected muscles, the tendon itself, and the local and central pain processing system.

• #60 “Tennis Elbow” Evolved

  https://consultqd.clevelandclinic.org/tennis-elbow-evolved

  Terms like tennis elbow, lateral epicondylitis and chronic elbow tendinitis have historically been used interchangeably in research publications and by health care providers to describe nonruptured pathology of the common extensor tendon of the elbow. However, these terms do not always characterize or reflect the true underlying intratendinous pathology. Some patients clinically present with an acute inflammatory tendinopathy, some with a chronic degenerative tendinopathy and others as a mix of these presentations. While it is generally accepted that tendinopathy develops due to overloading of tensile and compressive forces of the tendon over time, the natural progression of tendinopathy is not well understood. […] A reliable classification system for common extensor tendinopathy is a necessity.

• #61 “Tennis Elbow” Evolved

  https://consultqd.clevelandclinic.org/tennis-elbow-evolved

  While musculoskeletal ultrasound (MSK-US) has given us a reliable tool to outline different tendinopathy features, there has not been a widely-accepted classification system that has organized these findings. […] We constructed a new classification system based on these MSK-US identified features, and organized them into four distinct pathologic types. […] If successful, this classification could be used as a research standard for all common extensor tendinopathy treatments, including physical rehabilitation and therapy, bracing, orthobiologic injections and any minimally invasive office-based common extensor tendinopathy procedure.

• #62 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  Lateral epicondylalgia (LE or LET), formerly commonly known as tennis elbow is a condition of lateral elbow pain caused by overuse repetitive loading of the wrist extensor muscles. […] In their 2015 paper, these authors discuss the pathophysiology of LE. It is important to note that this condition is multidimensional. There are tendon cellular and matrix changes, alterations in nociceptive processing and muscle function changes that all feed into LE. […] From a tendon perspective research has shown that the cellular changes within the tendon are similar to other tendinopathies. Tendon pathology is now viewed as a continuum from reactive tendinopathy to degenerative tendinopathy. This model has previously been discussed, with a key message being that we no longer view tendon pain as an inflammatory process and tendinitis is no longer a suitable diagnostic term. In regards to LE, these authors discuss the tendon cellular and matrix changes that result in tendon dysfunction and immature healing but also how tendons respond to load and how training promotes healing.

• #63 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  Lateral epicondylalgia (LE or LET), formerly commonly known as tennis elbow is a condition of lateral elbow pain caused by overuse repetitive loading of the wrist extensor muscles. […] In their 2015 paper, these authors discuss the pathophysiology of LE. It is important to note that this condition is multidimensional. There are tendon cellular and matrix changes, alterations in nociceptive processing and muscle function changes that all feed into LE. […] From a tendon perspective research has shown that the cellular changes within the tendon are similar to other tendinopathies. Tendon pathology is now viewed as a continuum from reactive tendinopathy to degenerative tendinopathy. This model has previously been discussed, with a key message being that we no longer view tendon pain as an inflammatory process and tendinitis is no longer a suitable diagnostic term. In regards to LE, these authors discuss the tendon cellular and matrix changes that result in tendon dysfunction and immature healing but also how tendons respond to load and how training promotes healing.

• #64 Early Treatment is Key with Tennis Elbow

  https://burlingtonsportstherapy.com/blog/early-treatment-is-key-with-tennis-elbow/

  Acute tennis elbow is an injury to the muscles that extend the wrist and fingers. The pathology behind tennis elbow isnt fully understood, but its related to changes that occur at the tendon on the outer elbow. Its often known as lateral epicondylitis, but more current terms for this condition are extensor tendinosis or extensor tendinopathy. […] Tennis elbow occurs after overuse of the tendons and muscles in the forearm, near the elbow joint. […] This is characterized by pain, weakness and degeneration of the tendon. […] Physiotherapy addresses muscle tension (reduces the pull on the tendon and allows healing), and rehab exercises and movement is required (exercises to put the right forces to re-align tendon fibers strongly). […] The rehabilitation process can be tackled in a few phases. First phase is to decrease inflammation and pain while promoting tissue healing. The second phase involves improved flexibility and increased strength and endurance. The last phase deals with resolving your symptoms and gradually increasing your activity now that you have regained your full range of motion.

• #65 Lateral Epicondylitis – Injuries; Poisoning – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/injuries-poisoning/sports-injury/lateral-epicondylitis

  Lateral epicondylitis results from inflammation and microtearing of fibers in the extensor tendons of the forearm. […] Theories about the pathophysiology of lateral epicondylitis include nonathletic and occupational activities that require repetitive and forceful forearm supination and pronation, as well as overuse or weakness (or both) of the extensor carpi radialis brevis and longus muscles of the forearm, which originate from the lateral epicondyle of the elbow. […] With time, subperiosteal hemorrhage, calcification, spur formation on the lateral epicondyle, and, most importantly, tendon degeneration can occur. […] Lateral epicondylitis can result from repetitive and forceful forearm supination and pronation, and/or extension of the forearm and wrist; such motions involve the extensor carpi radialis brevis and longus muscles of the forearm, which originate from the lateral epicondyle of the elbow.

• #66 Lateral Epicondylitis (Tennis Elbow): Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/96969-overview

  Lateral epicondylitis (commonly referred to as tennis elbow) is related to excessive wrist extension. […] The most common overuse syndrome is related to excessive wrist extension and commonly referred to as tennis elbow, but it is actually more common in non-tennis players. […] Microscopic evaluation of the tendons does not show signs of inflammation, but rather angiofibroblastic degeneration and collagen disarray. […] The tendons are relatively hypovascular proximal to the tendon insertion. This hypovascularity may predispose the tendon to hypoxic tendon degeneration and has been implicated in the etiology of tendinopathies. […] Most typically, the primary pathology is tendinosis of the extensor carpi radialis brevis (ECRB) tendon 1-2 cm distal to its attachment on the lateral epicondyle. […] The causes of lateral epicondylitis include poor general conditioning, improper training, improper technique, poor or improper equipment, and scapular dyskinesis.

• #67 Lateral Epicondylitis (Tennis Elbow): Practice Essentials, Background, Functional Anatomy

  https://emedicine.medscape.com/article/96969-overview

  Lateral epicondylitis (commonly referred to as tennis elbow) is related to excessive wrist extension. […] The most common overuse syndrome is related to excessive wrist extension and commonly referred to as tennis elbow, but it is actually more common in non-tennis players. […] Microscopic evaluation of the tendons does not show signs of inflammation, but rather angiofibroblastic degeneration and collagen disarray. […] The tendons are relatively hypovascular proximal to the tendon insertion. This hypovascularity may predispose the tendon to hypoxic tendon degeneration and has been implicated in the etiology of tendinopathies. […] Most typically, the primary pathology is tendinosis of the extensor carpi radialis brevis (ECRB) tendon 1-2 cm distal to its attachment on the lateral epicondyle. […] The causes of lateral epicondylitis include poor general conditioning, improper training, improper technique, poor or improper equipment, and scapular dyskinesis.

• #68 Lateral epicondylitis of the elbow

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5367546/

  In addition, the tendon vascularisation is deficient and sustained muscle contractions can lead to tendon ischaemia. […] Repetitive activities increase temperature which can lead to hyperthermic injuries of the enthesis. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #69 Lateral epicondylitis of the elbow

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5367546/

  In addition, the tendon vascularisation is deficient and sustained muscle contractions can lead to tendon ischaemia. […] Repetitive activities increase temperature which can lead to hyperthermic injuries of the enthesis. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #70 Current concepts of natural course and in management of medial epicondylitis: a clinical overview | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/84275-current-concepts-of-natural-course-and-in-management-of-medial-epicondylitis-a-clinical-overview

  Medial epicondylitis (ME), called golfers elbow, is not frequent or serious disease but can cause symptoms that are bothersome in everyday life. […] In this article detailed information concerning pathophysiology and symptomatology of ME was described. […] Initially, inflammatory process was considered to play main role in ME development, and term suggesting an inflammation is still used, however histologically analysis showed that the mechanism of the disease is related to degeneration. […] The pathophysiology of ME involves supraphysiologic stress on the tendon that induces recurrent microtears and as a result angiofibroblastic hyperplasia occur. […] Vascular and fibroblastic elements replace the normal tendon, mucoid degenerates and reactive granulation tissue forms. […] Next, fibrosis or calcification can occur with decreasing collagen strength, scar tissue formation and thickening of the tendons.

• #71 Current concepts of natural course and in management of medial epicondylitis: a clinical overview | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/84275-current-concepts-of-natural-course-and-in-management-of-medial-epicondylitis-a-clinical-overview

  Medial epicondylitis (ME), called golfers elbow, is not frequent or serious disease but can cause symptoms that are bothersome in everyday life. […] In this article detailed information concerning pathophysiology and symptomatology of ME was described. […] Initially, inflammatory process was considered to play main role in ME development, and term suggesting an inflammation is still used, however histologically analysis showed that the mechanism of the disease is related to degeneration. […] The pathophysiology of ME involves supraphysiologic stress on the tendon that induces recurrent microtears and as a result angiofibroblastic hyperplasia occur. […] Vascular and fibroblastic elements replace the normal tendon, mucoid degenerates and reactive granulation tissue forms. […] Next, fibrosis or calcification can occur with decreasing collagen strength, scar tissue formation and thickening of the tendons.

• #72 Current concepts of natural course and in management of medial epicondylitis: a clinical overview | Published in Orthopedic Reviews

  https://orthopedicreviews.openmedicalpublishing.org/article/84275-current-concepts-of-natural-course-and-in-management-of-medial-epicondylitis-a-clinical-overview

  At this stage of the disease, patients are usually diagnosed. […] As the affected muscle attachment with a disturbed structure becomes more susceptible to further microtrauma, greater damage to the structure of the attachment may occur if the affected limb is subjected to further long-lasting unlimited activity. […] Depending on whether the ulnar nerve is also affected, ME is classified into two subtypes: without (type 1) and with (type 2) ulnar involvement.

• #73 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #74 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #75 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #76 “Tennis Elbow” Evolved

  https://consultqd.clevelandclinic.org/tennis-elbow-evolved

  Terms like tennis elbow, lateral epicondylitis and chronic elbow tendinitis have historically been used interchangeably in research publications and by health care providers to describe nonruptured pathology of the common extensor tendon of the elbow. However, these terms do not always characterize or reflect the true underlying intratendinous pathology. Some patients clinically present with an acute inflammatory tendinopathy, some with a chronic degenerative tendinopathy and others as a mix of these presentations. While it is generally accepted that tendinopathy develops due to overloading of tensile and compressive forces of the tendon over time, the natural progression of tendinopathy is not well understood. […] A reliable classification system for common extensor tendinopathy is a necessity.

• #77 How to diagnose Tennis Elbow or Lateral Elbow Tendinopathy with 6 simple tests – ReHand: Rehabilitation of hand, wrist and finger injuries via Tablet

  https://rehand.net/en/how-to-diagnose-an-epicondylitis-or-lateral-elbow-tendinopathy-with-6-simple-tests/

  Commonly known as Lateral Epicondylitis, Epicondylalgia or Tennis Elbow Tendinopathy, is one of the most prevalent conditions affecting the upper limb. This Epicondylitis is associated with pain and functional disability. […] Lateral Elbow Tendinopathy, or Tennis Elbow, is characterised by the presence of pain and functional disability associated with tendon dysfunction of the lateral epicondyle musculature. […] Although its frequency is important, its management is complex given the large number of clinical presentations, pathophysiology and differential diagnoses that can cause similar clinical presentation. […] The appearance of pain will be a sign of a possible diagnosis of lateral epicondylitis associated with extensor tendon disorder. […] An interesting paper by Dorf et al 2007 observed how maximal hand grip strength progressively decreased when changing position from elbow flexion to extension in patients with epicondylitis or lateral epicondylalgia tendinopathy.

• #78 “Tennis Elbow” Evolved

  https://consultqd.clevelandclinic.org/tennis-elbow-evolved

  While musculoskeletal ultrasound (MSK-US) has given us a reliable tool to outline different tendinopathy features, there has not been a widely-accepted classification system that has organized these findings. […] We constructed a new classification system based on these MSK-US identified features, and organized them into four distinct pathologic types. […] If successful, this classification could be used as a research standard for all common extensor tendinopathy treatments, including physical rehabilitation and therapy, bracing, orthobiologic injections and any minimally invasive office-based common extensor tendinopathy procedure.

• #79 Understanding the effects of tennis elbow – Personnel Today

  https://www.personneltoday.com/hr/understanding-the-effects-of-tennis-elbow/

  Local tendon pathology may result from overuse, tensile, compressive or shear forces, leaving the tendon in a debilitated state. Ultrasound imaging has identified structural changes associated with LE, including tendon thickening, thinning and tears. […] The pain gate theory of Melzack and Wall suggests a mechanism in the brain acting as a gate increasing or decreasing the flow of nerve impulses from the peripheral fibres to the central nervous system (CNS). This open gate allows the flow of nerve impulses, enabling the brain to perceive pain. […] There is evidence of dysfunction of the motor system in LE, including diminished strength, morphological changes and altered motor control. This explains the difficulty that Zara experienced when gripping and controlling objects, including the computer mouse and opening doors, which affected her day-to-day activities.

• #80 Tennis Elbow – lateral epicondylalgia | Kingsley Physio | More than your local Physio

  https://kingsleyphysio.com/common-conditions/tennis-elbow-lateral-epicondylalgia/

  Because tennis elbow is frequently left untreated until several months (or years) after the onset of symptoms, it is not uncommon to see concurrent enthespoathic changes on MRI or even plain film x-rays (see Achilles tendontits and enthesitis for further information on enthesopathies). […] ImageInflammation and even small tears of the extensor carpi radialis brevis muscle as it attaches to the lateral epicondyle may be present on MRI. This obscure but influential muscle has a comparatively small area of attachment to the bone at its origin. It is speculated that because of this it is more vulnerable and more readily traumatised by ballistic, rapid contractions such as may be seen in racquet sports.

• #81 How to diagnose Tennis Elbow or Lateral Elbow Tendinopathy with 6 simple tests – ReHand: Rehabilitation of hand, wrist and finger injuries via Tablet

  https://rehand.net/en/how-to-diagnose-an-epicondylitis-or-lateral-elbow-tendinopathy-with-6-simple-tests/

  Commonly known as Lateral Epicondylitis, Epicondylalgia or Tennis Elbow Tendinopathy, is one of the most prevalent conditions affecting the upper limb. This Epicondylitis is associated with pain and functional disability. […] Lateral Elbow Tendinopathy, or Tennis Elbow, is characterised by the presence of pain and functional disability associated with tendon dysfunction of the lateral epicondyle musculature. […] Although its frequency is important, its management is complex given the large number of clinical presentations, pathophysiology and differential diagnoses that can cause similar clinical presentation. […] The appearance of pain will be a sign of a possible diagnosis of lateral epicondylitis associated with extensor tendon disorder. […] An interesting paper by Dorf et al 2007 observed how maximal hand grip strength progressively decreased when changing position from elbow flexion to extension in patients with epicondylitis or lateral epicondylalgia tendinopathy.

• #82 How to diagnose Tennis Elbow or Lateral Elbow Tendinopathy with 6 simple tests – ReHand: Rehabilitation of hand, wrist and finger injuries via Tablet

  https://rehand.net/en/how-to-diagnose-an-epicondylitis-or-lateral-elbow-tendinopathy-with-6-simple-tests/

  The PRTEE is a reliable and valid questionnaire for the assessment of pain and disability associated with epicondylitis or lateral tendon epicondylalgia. […] The reliability of the questionnaire is excellent, with its total score with r2=0.87. Sensitivity to change pre-post treatment is related to the Thomsen Test (r2=84) and DASH (r2=0.66).

• #83 Impact of lifestyle and clinical factors on the prognosis of tennis elbow | Scientific Reports

  https://www.nature.com/articles/s41598-024-53669-x

  Our research reveals that alcohol consumption is an independent risk factor for poor treatment outcomes in patients with lateral epicondylitis. Particularly, heavy drinkers are 3.74 times more likely to require surgery within 1 year than occasional drinkers. We speculate that alcohol-induced inflammatory reactions contribute to disease progression. […] Our results suggest that, compared with oral NSAIDs alone, combined treatment with oral NSAIDs and local corticosteroid injections can reduce the likelihood of requiring surgical treatment. Inflammatory changes are often absent in the early stage of lateral epicondylitis. We speculate that patients with middle to late-stage tennis elbow exhibit inflammatory changes, and inflammatory diseases respond well to corticosteroid treatment.

• #84 Content – Health Encyclopedia – University of Rochester Medical Center

  https://www.urmc.rochester.edu/encyclopedia/content?ContentTypeID=85&ContentID=P00925

  Tennis elbow (lateral epicondylitis) is swelling of the tendons that bend your wrist backward away from your palm. […] The tendon most likely affected in tennis elbow is called the exterior carpi radialis brevis. […] Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. Your forearm muscles, which attach to the outside of your elbow, may become sore from excessive strain. When making a backhand stroke in tennis, the tendons that roll over the end of your elbow can become damaged. […] Its caused by repetitive motion of the forearm muscles, which attach to the outside of your elbow. The muscles and tendons get sore from too much strain. […] Tennis elbow can be treated with rest and medicines to help with the inflammation. Exercises often help too. In rare cases, surgery may be done to fix the tendon.

• #85 Tennis elbow

  https://pathologies.lexmedicus.com.au/collection/tennis-elbow-lateral-epicondylitis

  The typical symptoms of tennis elbow include pain to the lateral side of the elbow, which may radiate to the forearm and wrist. Pain increases with wrist extension and supination and subsides with rest. Occasionally the pain can be felt to the arm, postero-laterally. As a consequence of lateral epicondylitis the patient may develop weakening of grip strength. […] Lateral epicondylitis is primarily diagnosed by clinical examination. The patient’s history of sport or profession involving physical activities posing a risk for this pathology and past injuries will be discussed with the examiner. Clinical investigation focuses on the characteristics of pain at rest and during activity such as handshake and gripping. […] Conservative treatment for lateral epicondylitis is successful in 90-95% of patients following a standard regime including: Rest, Administration of NSAID’s, Splinting, Local injection of steroids, Autologous blood injections, Laser therapy, Extracorporeal shock wave therapy, Botox injection (pain treatment), Hyaluronate injections, Physical therapy.

• #86 Tennis Elbow (Lateral Epicondylitis) – Orthopedic Specialists of Seattle

  https://orthopedicspecialistsofseattle.com/healthcare/guidelines/tennis-elbow-lateral-epicondylitis/

  Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside (lateral side) of the elbow. […] The tendons involved are responsible for anchoring the muscles that extend or lift the wrist and hand. […] Pain relief is the main goal in the first phase of treatment. […] Orthotics can help diminish symptoms of tennis elbow. […] Nonoperative treatment is successful in approximately 85 percent to 90 percent of patients with tennis elbow. […] Surgery is considered only in patients who have incapacitating pain that does not get better after at least six months of nonoperative treatment. […] The surgical procedure involves removing diseased tendon tissue and reattaching normal tendon tissue to bone. […] Tennis elbow surgery is considered successful in approximately 90 percent of patients.

• #87 Tennis elbow

  https://pathologies.lexmedicus.com.au/collection/tennis-elbow-lateral-epicondylitis

  If symptoms do not improve after 6 to 12 months of conservative treatment surgery is recommended. This involves the debridement or removal of the tendon segment with evident tendinosis. This is followed by the reattachment of the extensor tendon to the bone. […] Rehabilitation for a tennis elbow focuses on physical exercises to strengthen the muscles of the forearm and increase their flexibility through regular stretching. Physical exercise is critical for the treatment of tennis elbow, whether operated or not, and offers a variety of approaches: Rest, Ice or heat, Taping or bracing during sport, Soft tissue massage, Electric stimulation, Ultrasound, Joint mobilisation, Progressive exercises to improve flexibility and strength, Postural correction. […] Introducing simple measures when practicing sport or other physical activities can help preventing a tennis elbow. Changing the characteristics of racquets with looser-strings, smaller, lighter and with smaller grips can reduce the stress on the forearm muscles and prevent recurrent tennis elbow.

• #88 Tennis elbow

  https://pathologies.lexmedicus.com.au/collection/tennis-elbow-lateral-epicondylitis

  If symptoms do not improve after 6 to 12 months of conservative treatment surgery is recommended. This involves the debridement or removal of the tendon segment with evident tendinosis. This is followed by the reattachment of the extensor tendon to the bone. […] Rehabilitation for a tennis elbow focuses on physical exercises to strengthen the muscles of the forearm and increase their flexibility through regular stretching. Physical exercise is critical for the treatment of tennis elbow, whether operated or not, and offers a variety of approaches: Rest, Ice or heat, Taping or bracing during sport, Soft tissue massage, Electric stimulation, Ultrasound, Joint mobilisation, Progressive exercises to improve flexibility and strength, Postural correction. […] Introducing simple measures when practicing sport or other physical activities can help preventing a tennis elbow. Changing the characteristics of racquets with looser-strings, smaller, lighter and with smaller grips can reduce the stress on the forearm muscles and prevent recurrent tennis elbow.

• #89 Lateral epicondylitis of the elbow in: EFORT Open Reviews Volume 1 Issue 11 (2016)

  https://eor.bioscientifica.com/view/journals/eor/1/11/2058-5241.1.000049.xml

  Lateral epicondylitis, also known as tennis elbow, is a very common condition affecting mainly middle-aged patients. […] The pathogenesis remains unknown but there appears to be a combination of local tendon pathology, alteration in pain perception and motor impairment. […] Though LE was classically identified as an inflammatory process, the histology does not show many inflammatory cells; most authors therefore consider LE as a tendinosis, a symptomatic degenerative process of the tendon. […] The application of tension to a tendon usually increases cross-linkage and collagen deposition. […] Painful symptomatic LE can result in underuse of the tendon. Underuse changes the tendon structure, leading to progressive weakening and increasing the risk of injury. […] Despite all of these considerations, there is a lack of knowledge to explain the great variability of symptoms among patients. Peripheral nerve irritation and local altered pain response have been proposed.

• #90 Elbow Tendinosis | Nirschl Orthopaedic Center

  https://www.nirschl.com/elbow-tendinosis/

  Kraushaar and Nirschl, in their review of tennis elbow, described chronic overuse injuries resulting from multiple microtraumatic events that accumulate to disrupt the internal structure of the tendon and lead to degeneration of the cells and cellular matrix. […] Nirschl has called this degenerative process a tendinosis, indicative of the failed intrinsic mechanism of the tendon to heal, rather than a tendinitis. […] A tendinitis implies an extrinsic blood borne response including the presence of inflammatory cells not evident in the histopathological studies of chronic overuse tendons. […] Nirschl and Petrone described these histopathological changes as angiofibroblastic tendinosis, a distinctly non-inflammatory, degenerative, avascular process involving the formation of immature and disorganized collagen with immature fibroblastic and vascular elements.

• #91 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  Lateral epicondylalgia (LE or LET), formerly commonly known as tennis elbow is a condition of lateral elbow pain caused by overuse repetitive loading of the wrist extensor muscles. […] In their 2015 paper, these authors discuss the pathophysiology of LE. It is important to note that this condition is multidimensional. There are tendon cellular and matrix changes, alterations in nociceptive processing and muscle function changes that all feed into LE. […] From a tendon perspective research has shown that the cellular changes within the tendon are similar to other tendinopathies. Tendon pathology is now viewed as a continuum from reactive tendinopathy to degenerative tendinopathy. This model has previously been discussed, with a key message being that we no longer view tendon pain as an inflammatory process and tendinitis is no longer a suitable diagnostic term. In regards to LE, these authors discuss the tendon cellular and matrix changes that result in tendon dysfunction and immature healing but also how tendons respond to load and how training promotes healing.

• #92 Understanding the effects of tennis elbow – Personnel Today

  https://www.personneltoday.com/hr/understanding-the-effects-of-tennis-elbow/

  An understanding of the underlying pathophysiology is helpful in understanding the effects of LE when making an assessment of the person in relation to their job tasks. An appreciation of the pathophysiological effects of this condition is helpful in order to understand changes to the structures involved.

• #93 Lateral Epicondylalgia – Pathophysiology & Clinical Assessment — Rayner & Smale

  https://www.raynersmale.com/blog/2017/2/10/lateral-epicondylalgia-pathophysiology-assessment

  On a more technical level, substance P and calcitonin gene-related peptide reactive nerve fibres have been located in the proximal ECRB tendon in conjunction with small blood vessels. […] In regards to pathophysiology, remember that LE is a multidimensional condition that involves three main components consisting of the affected muscles, the tendon itself, and the local and central pain processing system.

Zobacz więcej