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Humeral Epicondylitis in Elite Tennis Players and Indications for Elbow Arthroscopy

  • David M. Dare
  • Christopher L. Camp
  • Ioonna Felix
  • Joshua S. Dines
Chapter

Abstract

Tennis players are frequently exposed to repetitive, sudden, and explosive stressors during competition, resulting in demands on their musculoskeletal system that are unique to the sport. During a tennis stroke, the elbow is subject to extraordinarily high loads and forces. Not surprisingly, then, it is believed that elbow symptoms and injuries occur in at least 40–50% of tennis players at some point in their career [1, 2]. First described by Runge in 1873, lateral epicondylitis, or “tennis elbow,” is the most common upper extremity diagnosis in recreational tennis players, with injury rates ranging from 75% to 85% of elbow injuries [3–6].

References

  1. 1.
    Adelsberg S. The tennis stroke: an EMG analysis of selected muscles with rackets of increasing grip size. Am J Sports Med. 1986;14:139–42.CrossRefGoogle Scholar
  2. 2.
    Groppel JL, Nirschl RP. A mechanical and electromyographical analysis of the effects of various joint counterforce braces on the tennis player. Am J Sports Med. 1986;14:195–200.CrossRefGoogle Scholar
  3. 3.
    Cabrera JM, McCue FC. Nonosseous athletic injuries of the elbow, forearm, and hand. Clin Sports Med. 1986;5:681–700.PubMedGoogle Scholar
  4. 4.
    Giangarra CE, Conroy B, Jobe FW, et al. Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes. Am J Sports Med. 1993;21:394–9.CrossRefGoogle Scholar
  5. 5.
    Gruchow HW, Pelletier D. An epidemiologic study of tennis elbow. Incidence, recurrence, and effectiveness of prevention strategies. Am J Sports Med. 1979;7:234–8.CrossRefGoogle Scholar
  6. 6.
    Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003;22:813–36.CrossRefGoogle Scholar
  7. 7.
    Blackwell JR, Cole KJ. Wrist kinematics differ in expert and novice tennis players performing the backhand stroke: implications for tennis elbow. J Biomech. 1994;27:509–16.CrossRefGoogle Scholar
  8. 8.
    Dines JS, Bedi A, Williams PN, et al. Tennis injuries: epidemiology, pathophysiology, and treatment. J Am Acad Orthop Surg. 2015;23:181–9.  https://doi.org/10.5435/jaaos-d-13-00148.CrossRefPubMedGoogle Scholar
  9. 9.
    Riek S, Chapman AE, Milner T. A simulation of muscle force and internal kinematics of extensor carpi radialis brevis during backhand tennis stroke: implications for injury. Clin Biomech. 1999;14:477–83.  https://doi.org/10.1016/S0268-0033(98)90097-3.CrossRefGoogle Scholar
  10. 10.
    Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med. 1992;11:851–70.PubMedGoogle Scholar
  11. 11.
    Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999;81:259–78.CrossRefGoogle Scholar
  12. 12.
    Sharma P, Maffulli N. Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg. 2005;87:187–202.  https://doi.org/10.2106/JBJS.D.01850.CrossRefPubMedGoogle Scholar
  13. 13.
    Waugh EJ. Lateral epicondylalgia or epicondylitis: what’s in a name? J Orthop Sports Phys Ther. 2005;35:200–2.  https://doi.org/10.2519/jospt.2005.0104.CrossRefPubMedGoogle Scholar
  14. 14.
    Ahmad Z, Siddiqui N, Malik SS, et al. Lateral epicondylitis: a review of pathology and management. Bone Joint J. 2013;95(B):1158–64.  https://doi.org/10.1302/0301-620X.95B9.CrossRefPubMedGoogle Scholar
  15. 15.
    Coombes BK, Bisset L, Vicenzino B. A new integrative model of lateral epicondylalgia. Br J Sports Med. 2009;43:252–8.  https://doi.org/10.1136/bjsm.2008.052738.CrossRefPubMedGoogle Scholar
  16. 16.
    Perry J. Anatomy and biomechanics of the shoulder in throwing, swimming, gymnastics, and tennis. Clin Sports Med. 1983;2:247–70.PubMedGoogle Scholar
  17. 17.
    Morris M, Jobe FW, Perry J, et al. Electromyographic analysis of elbow function in tennis players. Am J Sports Med. 1989;17:241–7.  https://doi.org/10.1177/036354658901700215.CrossRefPubMedGoogle Scholar
  18. 18.
    Ryu RK, McCormick J, Jobe FW, et al. An electromyographic analysis of shoulder function in tennis players. Am J Sports Med. 1988;16:481–5.  https://doi.org/10.1177/036354658801600509.CrossRefPubMedGoogle Scholar
  19. 19.
    Kibler WB. Clinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis. Med Sci Sports Exerc. 1994;26:1203–6.CrossRefGoogle Scholar
  20. 20.
    Hatch GF, Pink MM, Mohr KJ, et al. The effect of tennis racket grip size on forearm muscle firing patterns. Am J Sports Med. 2006;34:1977–83.  https://doi.org/10.1177/0363546506290185.CrossRefPubMedGoogle Scholar
  21. 21.
    Smidt N, van der Windt DA. Tennis elbow in primary care. BMJ. 2006;333:927–8.  https://doi.org/10.1136/bmj.39017.396389.BE.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Marx RG, Sperling JW, Cordasco FA. Overuse injuries of the upper extremity in tennis players. Clin Sports Med. 2001;20:439–51.CrossRefGoogle Scholar
  23. 23.
    Van Hofwegen C, Baker CL, Baker CL. Epicondylitis in the Athlete’s Elbow. Clin Sports Med. 2010;29:577–97.  https://doi.org/10.1016/j.csm.2010.06.009.CrossRefPubMedGoogle Scholar
  24. 24.
    Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstructive operation. Clin Orthop Relat Res. 1970;72:248–53.PubMedGoogle Scholar
  25. 25.
    du Toit C, Stieler M, Saunders R, et al. Diagnostic accuracy of power Doppler ultrasound in patients with chronic tennis elbow. Br J Sports Med. 2008;42:572–6.  https://doi.org/10.1136/bjsm.2007.043901.CrossRefGoogle Scholar
  26. 26.
    Miller TT, Shapiro MA, Schultz E, Kalish PE. Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 2002;30:193–202.  https://doi.org/10.1002/jcu.10063.CrossRefPubMedGoogle Scholar
  27. 27.
    Tuite MJ, Kijowski R. Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med. 2006;25:387–408.  https://doi.org/10.1016/j.csm.2006.02.002.CrossRefPubMedGoogle Scholar
  28. 28.
    Coel M, Yamada CY, Ko J. MR imaging of patients with lateral epicondylitis of the elbow (tennis elbow): importance of increased signal of the anconeus muscle. Am J Roentgenol. 1993;161:1019–21.  https://doi.org/10.2214/ajr.161.5.8273602.CrossRefGoogle Scholar
  29. 29.
    Savnik A, Jensen B, Nørregaard J, et al. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol. 2004;14:964–9.  https://doi.org/10.1007/s00330-003-2165-4.CrossRefPubMedGoogle Scholar
  30. 30.
    Eygendaal D, Rahussen FTG, Diercks RL. Biomechanics of the elbow joint in tennis players and relation to pathology. Br J Sports Med. 2007;41:820–3.  https://doi.org/10.1136/bjsm.2007.038307.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006;333:939–0.  https://doi.org/10.1136/bmj.38961.584653.AE.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005;39:411–22.  https://doi.org/10.1136/bjsm.2004.016170.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Buchbinder R, Green SE, Youd JM, et al. Systematic review of the efficacy and safety of shock wave therapy for lateral elbow pain. J Rheumatol. 2006;33:1351–63.PubMedGoogle Scholar
  34. 34.
    Stasinopoulos D, Stasinopoulos I. Comparison of effects of exercise programme, pulsed ultrasound and transverse friction in the treatment of chronic patellar tendinopathy. Clin Rehabil. 2004;18:347–52.CrossRefGoogle Scholar
  35. 35.
    Decker MJ, Hintermeister RA, Faber KJ, Hawkins RJ. Serratus anterior muscle activity during selected rehabilitation exercises. Am J Sports Med. 1999;27:784–91.CrossRefGoogle Scholar
  36. 36.
    Kibler WB, Sciascia AD, Uhl TL, et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder rehabilitation. Am J Sports Med. 2008;36:1789–98.  https://doi.org/10.1177/0363546508316281.CrossRefPubMedGoogle Scholar
  37. 37.
    Jafarian FS, Demneh ES, Tyson SF. The immediate effect of orthotic management on grip strength of patients with lateral epicondylosis. J Orthop Sport Phys Ther. 2009;39:484–9.  https://doi.org/10.2519/jospt.2009.2988.CrossRefGoogle Scholar
  38. 38.
    Garg R, Adamson GJ, Dawson PA, et al. A prospective randomized study comparing a forearm strap brace versus a wrist splint for the treatment of lateral epicondylitis. J Shoulder Elbow Surg. 2010;19:508–12.  https://doi.org/10.1016/j.jse.2009.12.015.CrossRefPubMedGoogle Scholar
  39. 39.
    Wolf JM, Ozer K, Scott F, et al. Comparison of autologous blood, corticosteroid, and saline injection in the treatment of lateral epicondylitis: a prospective, randomized, controlled multicenter study. J Hand Surg Am. 2011;36:1269–72.  https://doi.org/10.1016/j.jhsa.2011.05.014.CrossRefPubMedGoogle Scholar
  40. 40.
    Bjordal JM, Lopes-Martins RA, Joensen J, et al. A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008;9:75.  https://doi.org/10.1186/1471-2474-9-75.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Trinh KV. Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. Rheumatology. 2004;43:1085–90.  https://doi.org/10.1093/rheumatology/keh247.CrossRefPubMedGoogle Scholar
  42. 42.
    Wong SM, Hui ACF, Tong P-Y, et al. Treatment of lateral epicondylitis with botulinum toxin: a randomized, double-blind, placebo-controlled trial. Ann Intern Med. 2005;143:793–7.CrossRefGoogle Scholar
  43. 43.
    Hayton MJ, Santini AJA, Hughes PJ, et al. Botulinum toxin injection in the treatment of tennis elbowa double-blind, randomized, controlled, pilot study. J Bone Joint Surg. 2005;87:503.  https://doi.org/10.2106/JBJS.D.01896.CrossRefPubMedGoogle Scholar
  44. 44.
    Paoloni JA, Appleyard RC, Nelson J, GAC M. Topical nitric oxide application in the treatment of chronic extensor tendinosis at the elbow: a randomized, double-blinded, placebo-controlled clinical trial. Am J Sports Med. 2003;31:915–20.CrossRefGoogle Scholar
  45. 45.
    Edwards SG, Calandruccio JH. Autologous blood injections for refractory lateral epicondylitis. J Hand Surg [Am]. 2003;28:272–8.  https://doi.org/10.1053/jhsu.2003.50041.CrossRefGoogle Scholar
  46. 46.
    Creaney L, Wallace A, Curtis M, Connell D. Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011;45:966–71.  https://doi.org/10.1136/bjsm.2010.082503.CrossRefPubMedGoogle Scholar
  47. 47.
    Kazemi M, Azma K, Tavana B, et al. Autologous blood versus corticosteroid local injection in the short-term treatment of lateral elbow tendinopathy. Am J Phys Med Rehabil. 2010;89:660–7.  https://doi.org/10.1097/PHM.0b013e3181ddcb31.CrossRefPubMedGoogle Scholar
  48. 48.
    Mishra A, Collado H, Fredericson M. Platelet-rich plasma compared with corticosteroid injection for chronic lateral elbow tendinosis. PM R. 2009;1:366–70.  https://doi.org/10.1016/j.pmrj.2009.02.010.CrossRefPubMedGoogle Scholar
  49. 49.
    Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34:1774–8.  https://doi.org/10.1177/0363546506288850.CrossRefPubMedGoogle Scholar
  50. 50.
    Rodik T, McDermott B. Platelet-rich plasma compared with other common injection therapies in the treatment of chronic lateral epicondylitis. J Sport Rehabil. 2016;25:77–82.  https://doi.org/10.1123/jsr.2014-0198.CrossRefPubMedGoogle Scholar
  51. 51.
    Nichols AW. Two-year follow-up of injection with platelet-rich plasma versus corticosteroid for lateral epicondylitis. Clin J Sport Med. 2012;22:451–2.  https://doi.org/10.1097/JSM.0b013e31826a091f.CrossRefPubMedGoogle Scholar
  52. 52.
    Palacio EP, Schiavetti RR, Kanematsu M, et al. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Rev Bras Ortop. 2016;51:90–5.  https://doi.org/10.1016/j.rboe.2015.03.014.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Nirschl RP, Pettrone FA. Tennis elbow. The surgical treatment of lateral epicondylitis. J Bone Joint Surg Am. 1979;61:832–9.CrossRefGoogle Scholar
  54. 54.
    Spencer GE, Herndon CH. Surgical treatment of epicondylitis. J Bone Joint Surg Am. 1953;35A:421–4.CrossRefGoogle Scholar
  55. 55.
    Calvert PT, Allum RL, Macpherson IS, Bentley G. Simple lateral release in treatment of tennis elbow. J R Soc Med. 1985;78:912–5.CrossRefGoogle Scholar
  56. 56.
    Verhaar J, Walenkamp G, Kester A, et al. Lateral extensor release for tennis elbow. A prospective long-term follow-up study. J Bone Joint Surg Am. 1993;75:1034–43.CrossRefGoogle Scholar
  57. 57.
    Kumar VS, Shetty AA, Ravikumar KJ, Fordyce MJ. Tennis elbow--outcome following the Garden procedure: a retrospective study. J Orthop Surg (Hong Kong). 2004;12:226–9.CrossRefGoogle Scholar
  58. 58.
    Baumgard SH, Schwartz DR. Percutaneous release of the epicondylar muscles for humeral epicondylitis. Am J Sports Med. 1982;10:233–6.CrossRefGoogle Scholar
  59. 59.
    Thornton SJ. Treatment of recalcitrant lateral epicondylitis with suture anchor repair. Am J Sports Med. 2005;33:1558–64.  https://doi.org/10.1177/0363546505276758.CrossRefPubMedGoogle Scholar
  60. 60.
    Owens BD, Murphy KP, Kuklo TR. Arthroscopic release for lateral epicondylitis. Arthroscopy. 2001;17:582–7.  https://doi.org/10.1053/jars.2001.20098.CrossRefPubMedGoogle Scholar
  61. 61.
    Peart RE, Strickler SS, Schweitzer KM. Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop (Belle Mead NJ). 2004;33:565–7.Google Scholar
  62. 62.
    Szabo SJ, Savoie FH, Field LD, et al. Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elbow Surg. 2006;15:721–7.  https://doi.org/10.1016/j.jse.2006.01.017.CrossRefPubMedGoogle Scholar
  63. 63.
    Yeoh KM, King GJW, Faber KJ, et al. Evidence-based indications for elbow arthroscopy. Arthrosc J Arthrosc Relat Surg. 2012;28:272–82.  https://doi.org/10.1016/j.arthro.2011.10.007.CrossRefGoogle Scholar
  64. 64.
    Kuklo TR, Taylor KF, Murphy KP, et al. Arthroscopic release for lateral epicondylitis: a cadaveric model. Arthroscopy. 1999;15:259–64.CrossRefGoogle Scholar
  65. 65.
    Baker CL, Baker CL. Long-term follow-up of arthroscopic treatment of lateral epicondylitis. Am J Sports Med. 2008;36:254–60.  https://doi.org/10.1177/0363546507311599.CrossRefPubMedGoogle Scholar
  66. 66.
    Solheim E, Hegna J, Øyen J. Arthroscopic versus open tennis elbow release: 3- to 6-year results of a case-control series of 305 elbows. Arthrosc J Arthrosc Relat Surg. 2013;29:854–9.  https://doi.org/10.1016/j.arthro.2012.12.012.CrossRefGoogle Scholar
  67. 67.
    Vangsness CT, Jobe FW. Surgical treatment of medial epicondylitis. Results in 35 elbows. J Bone Joint Surg Br. 1991;73:409–11.CrossRefGoogle Scholar
  68. 68.
    Field LD, Altchek DW. Elbow injuries. Clin Sports Med. 1995;14:59–78.PubMedGoogle Scholar
  69. 69.
    Elliott B, Fleisig G, Nicholls R, Escamilia R. Technique effects on upper limb loading in the tennis serve. J Sci Med Sport. 2003;6:76–87.  https://doi.org/10.1016/S1440-2440(03)80011-7.CrossRefPubMedGoogle Scholar
  70. 70.
    Field LD, Savoie FH. Common elbow injuries in sport. Sports Med. 1998;26:193–205.CrossRefGoogle Scholar
  71. 71.
    Gabel GT, Morrey BF. Operative treatment of medical epicondylitis. Influence of concomitant ulnar neuropathy at the elbow. J Bone Joint Surg Am. 1995;77:1065–9.CrossRefGoogle Scholar
  72. 72.
    Kurvers H, Verhaar J. The results of operative treatment of medial epicondylitis. J Bone Joint Surg Am. 1995;77(9):1374.CrossRefGoogle Scholar
  73. 73.
    Stahl S, Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint Surg Am. 1997;79:1648–52.CrossRefGoogle Scholar
  74. 74.
    Hechtman KS, Uribe JW, Botto-vanDemden A, Kiebzak GM. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics. 2011;34:92.  https://doi.org/10.3928/01477447-20101221-05.CrossRefPubMedGoogle Scholar
  75. 75.
    Richards RR, Regan WD. Medial epicondylitis caused by injury to the medial antebrachial cutaneous nerve: a case report. Can J Surg. 1989;32:366–7. 369.PubMedGoogle Scholar
  76. 76.
    Jobe C. Lateral and medial epicondylitis of the elbow. J Am Acad Orthop Surg. 1994;2:1–8.CrossRefGoogle Scholar
  77. 77.
    Ollivierre CO, Nirschl RP, Pettrone FA. Resection and repair for medial tennis elbow. A prospective analysis. Am J Sports Med. 1995;23:214–21.CrossRefGoogle Scholar
  78. 78.
    Grawe BM, FaBricant PD, Christopher C, et al. Clinical outcomes after suture anchor repair of recalcitrant medial epicondylitis. Orthopedics. 2016;39:e104.  https://doi.org/10.3928/01477447-20151222-09.CrossRefPubMedGoogle Scholar
  79. 79.
    Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg. 2001;9:99–113.CrossRefGoogle Scholar
  80. 80.
    Grana W. Medial epicondylitis and cubital tunnel syndrome in the throwing athlete. Clin Sports Med. 2001;20:541–8.CrossRefGoogle Scholar
  81. 81.
    Zonno A, Manuel J, Merrell G, et al. Arthroscopic technique for medial epicondylitis: technique and safety analysis. Arthroscopy. 2010;26:610–6.  https://doi.org/10.1016/j.arthro.2009.09.017.CrossRefPubMedGoogle Scholar
  82. 82.
    Grewal R, MacDermid JC, Shah P, King GJW. Functional outcome of arthroscopic extensor carpi radialis brevis tendon release in chronic lateral epicondylitis. J Hand Surg [Am]. 2009;34:849–57.  https://doi.org/10.1016/j.jhsa.2009.02.006.CrossRefGoogle Scholar
  83. 83.
    Lattermann C, Romeo AA, Anbari A, et al. Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. J Shoulder Elbow Surg. 2010;19:651–6.  https://doi.org/10.1016/j.jse.2010.02.008.CrossRefPubMedGoogle Scholar
  84. 84.
    Smith AM, Castle JA, Ruch DS. Arthroscopic resection of the common extensor origin: anatomic considerations. J Shoulder Elbow Surg. 2003;12:375–9.  https://doi.org/10.1016/mse.2003.S1058274602868239.CrossRefPubMedGoogle Scholar
  85. 85.
    Moskal MJ, Savoie FH, Field LD. Arthroscopic treatment of posterior elbow impingement. Instr Course Lect. 1999;48:399–404.PubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • David M. Dare
    • 1
  • Christopher L. Camp
    • 2
  • Ioonna Felix
    • 3
  • Joshua S. Dines
    • 4
    • 5
    • 6
  1. 1.Raleigh Orthopaedic ClinicRaleighUSA
  2. 2.Department of Orthopedic Surgery and Sports MedicineMayo ClinicRochesterUSA
  3. 3.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA
  4. 4.Sports Medicine and Shoulder ServiceHospital for Special SurgeryNew YorkUSA
  5. 5.Orthopedic SurgeryWeill Cornell Medical CollegeNew YorkUSA
  6. 6.Aspetar Sports Medicine HospitalDohaQatar

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