This paper reviews the clinical and occupational dimensions of lateral epicondylitis, commonly known as "tennis elbow." It examines the biomechanical mechanisms underlying the condition, including the role of repetitive motion and overuse of the extensor tendons. The paper also discusses medial epicondylitis as a related disorder. Legal and preventive considerations relevant to workplace injury in Canada are addressed, including patient privacy and psychological screening. Finally, the paper surveys both established and emerging assessment and management strategies — ranging from physical therapy and NSAIDs to low-level laser therapy, arthroscopic treatment, and suture anchor surgery — highlighting the importance of patient education in long-term recovery.
Lateral epicondylitis, commonly referred to as "tennis elbow," often results from pathological processes that occur within the elbow (Foley 281). This injury is most commonly the result of occupational stresses and not necessarily the result of racket sports, though the force involved in such sports may contribute to injury (Foley 282). Direct force is not necessary for the condition to arise; most cases result from repetitive motion or overuse rather than a single significant impact (Foley 292). Given this knowledge, one may assume that preventive measures can be implemented to reduce the frequency of the condition.
Lateral epicondylitis occurs as the muscle bellies of the forearm narrow and merge into the tendons, creating highly focused stress at the point where the tendons insert into the bone of the elbow (Nicholas 1). Injury to the outer, or lateral, portion of the elbow is considered one of the most common injuries in the sport of tennis — hence the name "tennis elbow" — and is commonly the result of overuse of the extensor tendons of the forearm, particularly the extensor carpi radialis brevis (Nicholas 1). The injury more commonly occurs in novice or amateur players and results from a combination of factors that may include poor technique, late swing preparation that results in wrist snap, hitting the ball with full force when serving, and pronating the wrists, which increases stress on the already taut extensor tendons (Nicholas 1).
Typically, pain results when the wrist is extended against resistance or during repetitive actions with the wrist and elbow extended (Foley 282). Causes may include a lesion at the wrist extensor mechanism or near the lateral epicondyle of the humerus (Foley 282). Studies utilizing ultrasound diagnosis suggest that a relationship exists between lateral epicondylitis and intratendinous calcification, tendon thickening, adjacent bone irregularity, focal hypoechoic regions, and diffuse heterogeneity (Levin et al. 230).
Another form of epicondylitis, referred to as medial epicondylitis, can occur when a player snaps the wrist sharply during the course of play or when a tremendous amount of force is placed on the medial tissues surrounding the elbow, typically during the serve portion of play (Nicholas 1). Improper techniques, such as an incorrect backstroke, can also contribute to this condition.
Any activity that results in repetitive motion and stress or strain on the elbow can result in pain or injury consistent with epicondylitis. Those most commonly affected include individuals engaging in tennis, golf, swimming, typing, construction work, handshaking, and any other activity that requires frequent or repetitive motion (Nicholas 1).
In Canada and other countries, legal concerns related to lateral epicondylitis include appropriate diagnosis and assessment of whether the injury has resulted from repetitive occupational motion or from an abrupt injury unrelated to a job role or work function (Crossman et al. 100). Patient education and a patient disability inventory may be warranted in many cases to evaluate what treatment modalities are appropriate for a given situation (Crossman et al. 100). In the case of work-related injuries, prevention is key; diagnostic tools and preventive steps should be taken to ensure that patients are aware of what motions may exacerbate or contribute to their condition. Appropriate measures may include establishing an ergonomic work environment to prevent injury when possible (Crossman et al. 100).
Newer evidence has focused on adopting psychological measures to assist patients suffering from pain associated with lateral epicondylitis and related conditions. These studies suggest that psychological issues may exist in some patients experiencing certain forms of pain, and therefore physicians must have greater awareness of a patient's broader medical state prior to diagnosis (Crossman et al. 100). This introduces additional legal challenges, as physicians and workforce organizations must ensure the privacy of patients undergoing psychological screening remains confidential and secure. In most cases, patient consent to treatment will need to be obtained in order to fully ascertain the influences on a patient's health and well-being when diagnosed with lateral epicondylitis or associated disorders.
"MRI, ultrasound, and physical examination methods"
"Therapy, surgery, and emerging treatment options"
"Teaching patients to prevent recurrence"
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