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Published byEleanore Martin Modified over 9 years ago
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Tennis Elbow Definition: – “Tendinopathy of the common extensor origin of the elbow” – Previously known as “lateral epiconylitis” – 1-2% population
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Aetiology Incompletely understood Acute injury – Epicondylitis Chronic injury – Epicondylosis – Repetitive micro-tearing
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Tendinosis Mucoid degeneration Loss of collagen tight bundled structure Fibrosis Neo-vascularisation (Khan et al. 1999)
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Presentation Pain Weakness Difficulty opening door handles Difficulty shaking hands
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Examination Pain on palpation Resisted elbow extension Resisted middle finger extension
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Treatment Non-operative – Rest – NSAIDs – Physiotherapy – USS – Injection therapy Operative – Tennis elbow release
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NSAIDs Cochrane review 2002 Insufficient evidence to recommend or discourage the use of oral NSAIDs No conclusion regarding oral versus topical
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Physiotherapy Principles: – Eccentric loading – Close to limit of tendon without exceeding it – Avoid exacerbating activities
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Physiotherapy Bisset et al BMJ 2006 – 52 week FU – No better outcome than “wait and see” – BUT took less adjunctive medications Tyler et al JSES 2010 – Eccentric exercises beneficial – 7 weeks only FU
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Cortisone Injections Common treatment ? Beneficial with degenerative pathology Significant local side-effects
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Effectiveness Short-term improvement (6-8 weeks) Long-term deleterious effect – Evident at 6 and 12 months Coombes et al Systematic Review Lancet 2010
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Injection of blood products Attempt to address pathology Growth Factors e.g. TGF-ß + FGF Autologous blood Platelet Rich Plasma (PRP) Bone Marrow Aspirate
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Autologous blood Connel D.A. et al (2006) Ultrasound-guided autologous blood injection for tennis elbow. Skeletal Radiology 35;6:371-7. Edwards, S.G. and Calandruccio, J.H. (2003) Autologous blood injections for refractory lateral epicondylitis. The Journal of Hand Surgery 28A; 2; 272-9.
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Platelet Rich Plasma Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma. Mishra A and Pavelko T, Am J Sports Med 2006 Autologous growth factor injections in chronic tendinopathy: a systematic review Vos RJ et al. Br J Sports Med Sep 2010 Ongoing Positive Effect of an Autologous Platelet Concentrate in Lateral Epicondylitis in a Double-Blind Randomized Controlled Trial Platelet-Rich Plasma Versus Corticosteroid Injection With a 2-Year Follow- up Gosens T, Peerbooms JC et al. Am J Sports Med 2011
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Botulinum Toxin A Injection Paralysis of extensor musculature Unloading of tendon Gradual reload as toxin diminishes Keizer et al 2002 Clin Orth Rel Research
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Extracorporeal shockwave therapy Regular tennis elbow – Evidence lacking Calcific tennis elbow (very rare) – Possible benefit
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Heal with Steel? Reserved for refractory cases Debridement of abnormal tendon of ERCB
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Conclusion What should we do? Corticosteroids should be used cautiously Physiotherapy Avoid exacerbating factors Blood products appear promising Surgery as a last resort
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