Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment

Abstract

Lateral epicondylitis (tennis elbow) is the most frequent type of myotendinosis and can be responsible for substantial pain and loss of function of the affected limb. Tennis biomechanics, player characteristics and equipment are important in preventing the condition. This article presents an overview of the current knowledge on lateral epicondylitis, and focuses on treatment strategies. Conservative and surgical treatment options are discussed, and recent techniques are outlined.

Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis

“…Even though less than 10% of patients are tennis players, around 50% of the players, particularly novice and single-handed backhand players, experience lateral elbow pain in their lifetimes with 75% of them representing true 30 LE (Ollivierre and Nirschl, 1996). The condition affects functional capacity of the affected limb with subsequent impact on player's professional and social life (De Smedt et al, 2007).…”

“…The high involvement of wrist extensors in performing all major tennis strokes throughout play may lead to excessive overloading of this muscular group as a result of repeated large impact forces. There has been a particular interest in the role of single-handed backhand that is used for both defensive and offensive functions in a tennis game (De Smedt et al, 2007;Elliott, 2006;Eygendaal et al, 2007). It is a fairly accepted concept that applying a one-handed 80 backhand stroke increases the risk of LE as mainly sequential end-points of one upper extremity (i.e.…”

“…Biomechanical studies of three basic tennis strokes (overhead or serve, forehand and backhand) have projected a predominant activity of wrist extensors in all tennis strokes, backhand in particular, that would explain the predisposition of common extensor origin for injury (De Smedt et al, 2007;Elliott, 75 1988;Eygendaal et al, 2007). The high involvement of wrist extensors in performing all major tennis strokes throughout play may lead to excessive overloading of this muscular group as a result of repeated large impact forces.…”

“…This high impact load resulted from combined valgus forces and rapid extension ('valgus extension overload') may lead to compression forces on the lateral aspect of elbow near the common origin of wrist extensors (Andrews and Whiteside, 1993;Eygendaal et al, 2007;Morrey et al, 1991). Finally, some reports have highlighted 60 the role of altered muscle recruitment patterns and activation imbalances for predisposition to the LE as such predominant activity of the wrist extensors observed in the majority of tennis strokes (serve, forehand, one-and two-handed backhand) may predispose the wrist extensors and pronator teres muscles to the LE injury (De Smedt et al, 2007;Kelley et al, 1994). Other proposed factors that can potentially contribute to increased transmission of high impact loads to the extensor mass include 65 training and technical errors, poor racket (inappropriate grip size and weight), strength deficits/muscle imbalances, and forceful gripping (Alizadehkhaiyat et al, 2007b;Bartlett, 2012;Bunata et al, 2007;De Smedt et al, 2007;Eygendaal et al, 2007;Herquelot et al, 2013;Pitzer et al, 2014).…”

Assessment of the risk and biomechanical consequences of lateral epicondylalgia by estimating wrist and finger muscle capacities in tennis players

“…Nevertheless, the shock wave propagation factor has been clearly associated with modifications of forearm muscle activities (Wei, Chiang, Shiang, & Chang, 2006) and might therefore participate in the pathology development. Backhand strokes have also been assumed to be a primary factor in the pathology, mainly because they induce an eccentric stretching of wrist extensors (De Smedt, De Jong, Van Leemput, Lieven, & Van Glabbeek, 2007;Knudson & Blackwell, 1997;Knudson, 2004). However, as with vibration phenomenon, this factor can be considered as secondary only since lateral epicondylalgia is caused by other activities which do not involve any eccentric actions of extensor muscles, e.g.…”