{"id":11423,"date":"2024-12-23T06:00:31","date_gmt":"2024-12-23T05:00:31","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=11423"},"modified":"2024-12-19T17:41:23","modified_gmt":"2024-12-19T16:41:23","slug":"the-msk-playbook-tennis-elbow","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2024\/12\/23\/the-msk-playbook-tennis-elbow\/","title":{"rendered":"The MSK playbook: Tennis elbow"},"content":{"rendered":"

Tennis elbow (or lateral epicondylitis) is a common upper limb condition seen in the musculoskeletal (MSK) clinic. It can cause significant pain, restriction to activity and impact patients Quality of life (QoL). Despite the name, it has little to do with tennis and our understanding of this condition has led us to appreciate the wider metabolic, degenerative, overuse and inflammatory risk factors involved.\u00a0<\/span><\/p>\n

Rather than being a single condition with a defined set of risk factors to optimise – MSK clinicians should adapt a personalised and targeted approach to treatment. This should consider the loading potential, metabolic health and Otho biologic, injection and orthopaedic interventions.<\/span><\/p>\n

Going beyond overuse and inflammation theories<\/b><\/p>\n

Tennis elbow was traditionally thought of as an overuse injury, that occurs in patients where the common extensor tendon is being challenged beyond its mechanical capacity (<\/span>1)<\/span>. Varying degrees of inflammation or degeneration have also been proposed as contributing factors to the condition and they can influence decisions about treatment options.\u00a0<\/span><\/p>\n

Breaking down tennis elbow: what do we know about common risk factors?<\/b><\/p>\n

Newer theories of tendon related pain (tendinopathy) have helped us move away from pure imaging or histology-based criteria. Chronic sensitisation (<\/span>1)<\/span>, neurogenic sensitisation, menstrual (<\/span>2)<\/span> and metabolic health (<\/span>2)<\/span> have all been linked to tendon related pain and are important risk factors to be aware of alongside known intrinsic and extrinsic risk factors:\u00a0<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
Tennis elbow risk factors<\/td>\n<\/tr>\n
Intrinsic risk factors<\/td>\nExtrinsic risk factors<\/td>\n<\/tr>\n
No gender bias (3)<\/td>\nWork\/daily function requirements (4)<\/td>\n<\/tr>\n
Metabolic syndrome (5) (hypertension, dyslipidaemia (6), type II diabetes) (7)<\/td>\nSport technique (8)<\/td>\n<\/tr>\n
Age 30-50 (9)<\/td>\nRacquet factors (10,11) e.g. quality, string tension<\/td>\n<\/tr>\n
Increased carrying angle (12)<\/td>\nSporting load management<\/td>\n<\/tr>\n
Muscular imbalance between rotator cuff\/scapula and wrist flexors and extensors13<\/td>\nSmoking (5)<\/td>\n<\/tr>\n
<\/td>\nAlcohol (5)<\/td>\n<\/tr>\n
Menopause, perimenopause (14,15)<\/td>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Table 1: <\/span><\/i>Tennis elbow risk factors<\/span><\/i><\/p>\n

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Figure 1:<\/span><\/i> A summary poster of intrinsic and extrinsic risk factors for tennis elbow<\/span><\/i><\/p>\n

Tennis elbow: How common is it ?<\/b><\/p>\n