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What is Tennis Elbow?


Tennis elbow, or lateral epicondylitis, is an overuse tendinopathy of the lateral wrist extensor muscles where they insert at the elbow. This condition occurs most commonly in adults between 30 and 50 years, with risk factors including repetitive use of the elbow, tobacco use, and other hand issues such as carpal tunnel syndrome and de Quervain’s tenosynovitis. The cause of pain and disability in lateral epicondylitis is unknown. It is likely to be multifactorial with an emphasis on repetitive microtrauma and overuse in genetically predisposed individuals.

Who does it affect?

Lateral epicondylitis affects 1–3 % of adults in the general population each year [1, 34]. However, the incidence may differ depending on the population of interest as more than 50 % of amateur tennis players reported having been affected with lateral epicondylitis at some point in their career [19]. Typically, adults in the fourth or fifth decade of life are affected. Males and females are affected equally [10, 30], and oftentimes it is the dominant arm that is symptomatic.

Manual laborers, smokers, and those who repetitively bend/straighten their elbow for more than 1 h/day and have poor social support have been associated with higher rates of lateral epicondylitis [10, 14, 30, 35]. The burden on the economic system is substantial, with 5 % of the affected working-age subjects reporting work absence because of elbow symptoms in the past 12 months [35]. In addition, comorbid conditions, including rotator cuff pathology, DeQuervain’s disease, carpal tunnel syndrome, and oral corticosteroid therapy, have been shown to be independent risk factors for developing lateral epicondylitis. The exact mechanism for this is unclear [33].

How effective is Shockwave Therapy as a treatment?

At Physio Tullamore we use the most evidence based treatments. Below is a study looking at the effectiveness of Shockwave Therapy for the treatment of Tennis Elbow.

Title: Efficacy of low-energy extracorporeal shockwave therapy and a supervised clinical exercise protocol for the treatment of chroniclateral epicondylitis: A randomised controlled study

(Author/Creator: Sarkar, Bibhuti ; Das, Pooja Ghosh ; Equebal, Ameed ; Mitra, Puspal Kumar ; Kumar, Ratnesh ; Anwer, Shahnawaz (Hong Kong Physiotherapy Journal, 2013, Vol.31(1), pp.19-24 [Peer Reviewed Journal])

Subjects: extracorporeal shockwave therapy ; lateral epicondylitis ; supervised exercise protocol

Description: This randomised controlled trial was designed to evaluate the efficacy of low-energy extracorporeal shockwave therapywith a supervised exercise protocol for the treatment of chronic lateral epicondylitis. Thirty patients of lateral epicondylitis were randomly placed into two groups: an experimental group (n = 15) and a control group (n = 15). The experimental group received low-energy extracorporeal shockwave therapy and supervised exercise once a week for 3 weeks, whereas the control group received a supervised exercise protocol three times a week. Both the groups were instructed to carry out a home exercise programme twice daily for 4 weeks.Outcome parameters included in this study were pain intensity, pain-free grip strength, and the Disability of Arm, Shoulder, and Hand questionnaire. Data were collected at baseline and after the end of treatment (at 4th week). There was a decline in pain, and improvements in pain-free grip strength and limb function in both groups compared with the baseline values. At the end of the treatment period, the experimental group had greater reduction in pain intensity and better improvement in limb function (p < 0.01).

It can be concluded that low-energy extracorporeal shockwave therapy, when combined with regular exercise, is an effective method for reducing pain and improving upper limb function in patients with chronic lateral epicondylitis.

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