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Tennis elbow
 A tennis elbow is one of the most frequent and invalidating tendinous lesions in the elbow region.
Mostly there is a lesion of the m. extensor carpi radialis brevis at the tenoperiostal site (Type II)
In total 4 types of tennis elbow are described, each with a specific treatment strategy. A combination lesion of the extensor carpi radialis brevis and longus tendon is also a possiblity.
Tennis elbow (2)
Not only the clinical image but also the specific history points in the direction of a tennis elbow.
According to Cyriax, tennis elbow is a lesion of the wrist extensors. On examination, wrist extension is found to be positive for pain.
In theory, when the wrist extension is painful, we can think of six different muscles :
* extensor carpi radialis longus and brevis
* extensor carpi ulnaris
* extensor digitorum communis
* extensor indicis proprius
* extensor digiti quinti.
How to distinguish ?
If we repeat the test, this time with active finger flexion (make a fist), and it remains positive, we can eliminate three of the six muscles (the finger extensors). Further differentiation, between radial and ulnar wrist extensors, is obtained by resisted radial and ulnar deviation.
When we have found that the radial extensors are responsible for the pain, we need palpation to find the precise localization. We palpate four different spots for tenderness in both arms, so that the patient can compare.
The age of the patient varies between 30-60 years. Without appropiate treatment, the lesion can go on for months, even years. This is an example of the so called "self-perpetuating inflammation".
Types
In a type 1 tennis elbow, the lesion lies in the extensor carpi radialis longus ; in the other types the brevis muscle is affected.
Type 1 : supracondylar
Type 2 : tenoperiosteal
Type 3 : body of the tendon
Type 4 : muscle belly.
Type 2 is seen very frequently. It is also the most disabling variant : carrying weight, pouring coffee, picking up the phone, shaking hands could all be most painful. There might be radiation of pain into the fingers 2-3-4.
Specifically torsion movements can cause very painful twinges.
It is the only type of tennis elbow with a tendency to spontaneously recover. Generally this takes about 1 year in a patient younger then 60 years. If older, 2 years becomes more likely. This rule only applies as long as the patient has not had a steroid infiltration.
It is remarkable that this type 2 tennis elbow is the only tenoperiosteal lesion in the entire body for which deep friction alone is ineffective. It is treated, after a preliminary deep friction (= anaesthetic effect), by manipulation/stretching.
Friction massage tennis elbow type 1
Friction massage tennis elbow type 2
Friction massage tennis elbow type 3
(See books Part I, p64-65 ; Part II, p13-14)
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