Lateral epicondylitis is a painful condition that affects the lateral aspect of the elbow, usually centered around the epicondyle of the humerus. Historically called tennis elbow, this condition occurs in both men and women, usually in the 35- to 50-year age range, and rarely in tennis players. Patients present with laterally based elbow pain, exacerbated with repetitive stresses to the wrist and finger extensors, specifically the extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC). A distinct pathoetiology has not been elucidated, and as such most patients have an idiopathic source, although some patients report “work-related” causes. Direct trauma is rarely a source of tennis elbow pain, neither is tennis, as only 5–10% of patients with lateral epicondylitis are tennis players.1 Most patients report an insidious onset with pain associated with gripping, carrying, and holding objects with the forearm in pronation and the elbow in extension.
The natural history of tennis elbow is that it will usually resolve over time, but often with a protracted course. Numerous nonoperative and operative modalities to treat lateral epicondylitis have been described in the literature, although determining the “best” treatment is difficult if not impossible based on the literature.1–15 Currently, most patients who are indicated for operative treatment of their painful tennis elbow are managed with one of two procedures, a formal open release, as described originally by Hohmann, and modified by Nirschl, or an arthroscopic release.6,9 A review of the literature will reveal support for both open and arthroscopic techniques, and until a well-designed prospective, randomized trial comparing these techniques is available, many surgeons are guided by “their subjective viewpoint and clinical experience.”16 As such, we will describe the open and the arthroscopic procedures to treat patients with tennis elbow, both of which adhere to the principles of minimally invasive procedures.
Radial Head Lateral Epicondyle Open Release Tennis Player Extracorporeal Shock Wave Therapy
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