1. Tennis elbow

2. Is lateral epicondylitis Resisted forearm movement eg tennis forearm, wringing, scraping out pigeon lofts Overuse musculoskeletal disorder

3. Tennis elbow Very common –4-7/1000/yr –Recurrence “Persistently effective treatments have resisted researchers” ARC February 2007

4. Tennis elbow Local steroid injections –Popular –Short term pain relief – 6 weeks –Little better than placebo or time over the longer term –Worse between 12 weeks and one year than wait and see Physio –Longer term benefit form 12 weeks to 1 year

5. Tennis elbow Separating the patients Payment by volume eg bricklayer, plasterer DIY eg 1 weekend per year wallpapering Research so far No evidence on how best to manage any subgroup Outcome Likely recurrence Good whatever

6. Understanding tendon disorders Tendinopathy, not tendinitis Degeneration and inadequate repair, not inflammation Therefore NSAIDs for short term pain relief only

7. How to encourage repair and rehabilitation? Don’t know Currently physios use stretching and eccentric loading of extensor carpi radialis brevis for tennis elbow Similar approach for –Achilles tendon –Rotator cuff –Patellar tendon –Golfers elbow