Tennis elbow doesn't just affect tennis players, but also barbecue chefs? Explanation of lateral epicondylitis

Author: Yao Shiyi, postdoctoral fellow at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine

Reviewer: Wang Lei, Chief Physician, Ruijin Hospital, Shanghai Jiaotong University School of Medicine

Master Zhang, 50, recently visited a doctor and reported severe pain in both elbows. After inquiring about his medical history, we learned that Master Zhang, as the owner of a barbecue restaurant, had worked hard for a long time and his barbecue skills were highly praised by diners, but he also overused his elbows and unfortunately suffered from "tennis elbow." Faced with the diagnosis, Master Zhang was puzzled: "What does my barbecue job have to do with tennis?"

Tennis elbow, medically known as lateral epicondylitis, is an inflammation of the forearm extensor tendon at the attachment point of the lateral epicondyle of the humerus. The disease was originally named because it is common among tennis players, but in fact, it is not only tennis players who are susceptible to it, but also amateur athletes who lack professional guidance, housewives who frequently do housework, and manual laborers who repeatedly exert force on their elbows for a long time, such as barbecue chefs. The common feature of these people is that they frequently rotate their forearms and flex and extend their elbows, which leads to aseptic inflammation of the periosteum, synovium, and tendons of the elbow joints.

1. How to quickly determine whether you have tennis elbow?

If you have pain in your elbow, you can tell whether it is tennis elbow by:

1. Confirm whether you are a high-risk group for tennis elbow, that is, whether you frequently rotate your forearm and flex and extend your elbow in daily life.

2. Check yourself to see if there is pain on the outside of your elbow when you grasp heavy objects, if the pain worsens when you open a door or twist a towel, and if the pain eases after rest.

3. Perform self-test movements (please refer to the video demonstration for details): straighten your elbow, make a fist, and rotate your forearm so that your palm faces up. If there is pain on the outside of your elbow (where the left index finger is pressed in the video), you probably have tennis elbow.

Tennis elbow self-test video

2. How to deal with tennis elbow?

1. Once pain occurs, rest the elbow joint immediately and avoid movements that cause pain.

2. Wear special tennis elbow guards to protect the affected limb.

3. When the pain is obvious during the acute phase, anti-inflammatory analgesic drugs or plasters can be used for treatment.

4. After the acute pain is relieved, you can do recovery exercises

(1) Wrist extension and flexion exercises: 3 times a day, 5 sets each time, 15 seconds each for extension and flexion (you can add a water bottle for weight training).

(2) Palm strength exercises: 2 times a day, 3 sets each time, 20 reps per set.

(3) Forearm rotation exercise: 2 times a day, 3 sets each time, 10 reps per set (you can add a water bottle for weight training).

Palm strength training video

Wrist extension and flexion exercise video

Forearm rotation exercise video

If there is still no obvious effect after using the above methods, in order to avoid worsening of the condition, the patient should go to the hospital for regular treatment in time.

3. Choice of hospital for tennis elbow treatment

1. Extracorporeal shock wave therapy: A non-invasive procedure that uses shock waves to act on the tendons to directly relieve pain, while promoting local blood circulation and inhibiting the transmission of pain signals.

Figure 1 Copyright image, no permission to reprint

2. Corticosteroid or platelet-rich plasma injection therapy: Corticosteroids can relieve pain and swelling caused by inflammation; platelet-rich plasma achieves the therapeutic effect by injecting concentrated platelet plasma extracted from autologous blood.

Figure 2 Copyright image, no permission to reprint

3. Surgical treatment: If other treatments are ineffective, surgery to remove the damaged tissue may be considered, including open surgery and elbow arthroscopy.

Figure 3 Copyright image, no permission to reprint

4. How to prevent tennis elbow?

Tennis elbow is a chronic strain disease. Long-term overuse of the elbow joint can easily lead to tendon degeneration. To prevent tennis elbow, you should try to reduce long-term and excessive elbow rotation and flexion and extension exercises, massage and relax the elbow joint in time, maintain good living habits, combine work and rest, eat a balanced diet, and exercise appropriately.

References

[1]Assendelft W, Green S, Buchbinder R, Struijs P, Smidt N. Tennis elbow. BMJ. 2003 Aug 9;327(7410):329. doi: 10.1136/bmj.327.7410.329. PMID: 12907489; PMCID: PMC1126728.

[2]Liu WC, Chen CT, Lu CC, Tsai YC, Liu YC, Hsu CW, Shih CL, Chen PC, Fu YC. Extracorporeal Shock Wave Therapy Shows Superiority Over Injections for Pain Relief and Grip Strength Recovery in Lateral Epicondylitis: A Systematic Review and Network Meta-analysis. Arthroscopy. 2022 Jun;38(6):2018-2034.e12. doi: 10.1016/j.arthro.2022.01.025. Epub 2022 Jan 31. PMID: 35093494.

[3]Kim CH, Park YB, Lee JS, Jung HS. Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022 Feb;31(2):428-436. doi: 10.1016/j.jse.2021.09.008. Epub 2021 Oct 14. PMID: 34656779.

[4]Orchard J, Kountouris A. The management of tennis elbow. BMJ. 2011 May 10;342:d2687. doi: 10.1136/bmj.d2687. PMID: 21558359.