1. Tutorial Finding information(1) 28/3/06O.Arikawe

2. Tennis elbow DEFINITION: DEFINITION: pain and tenderness over the lateral epicondyle and pain on resisted wrist extension. pain and tenderness over the lateral epicondyle and pain on resisted wrist extension.INCIDENCE: 4 – 7 / 1000 per year in general practice. Peak incidence between 40 -50 years. 4 – 7 / 1000 per year in general practice. Peak incidence between 40 -50 years.

3. AETIOLOGY AETIOLOGY repeated strain result in inflammation of the common extensor tendon where it inserts into the epicondyle repeated strain result in inflammation of the common extensor tendon where it inserts into the epicondyle

4. It could also occur after minor or unrecognized trauma of the extensor muscles of the fore arm. It could also occur after minor or unrecognized trauma of the extensor muscles of the fore arm. Tennis is a direct cause in only about 5%. Tennis is a direct cause in only about 5%.

5. PROGNOSIS: self limiting. self limiting. minority of cases persist for 18 months to 2 years or longer. minority of cases persist for 18 months to 2 years or longer. 10% - 20% of episodes result in 12 weeks absence from work. 10% - 20% of episodes result in 12 weeks absence from work.

6. Sources of information Clinical evidence Clinical evidence Bandolier Bandolier medline/medscape medline/medscape On medica On medica Doctors.net.uk/pubmed Doctors.net.uk/pubmed Nice guidelines Nice guidelines Textbooks Textbooks Journals – BMJ, BJGP Journals – BMJ, BJGP

7. Possible treatments for tennis elbow Topical NSAIDS for short term pain relief Topical NSAIDS for short term pain relief oral NSAIDS for short term pain relief oral NSAIDS for short term pain relief Corticosteroid injections Corticosteroid injections Acupuncture Acupuncture Exercise and mobilization Exercise and mobilization NSAIDS for longer term pain relief NSAIDS for longer term pain relief Braces(orthoses) Braces(orthoses)

8. Surgery Surgery Extra corporeal shock wave therapy Extra corporeal shock wave therapy Physiotherapy Physiotherapy Botulinum toxin injection Botulinum toxin injection Topical nitric oxide patch Topical nitric oxide patch Ionotophoretic steroid delivery Ionotophoretic steroid delivery

9. Best treatment option Topical NSAIDS for short term pain relief. Evidence: cochrane review abstract based on meta- analysis of controlled clinical trials cochrane review abstract based on meta- analysis of controlled clinical trials Clinical evidence search and appraisal April 2003