Stress syndromes of the elbow joint region (golfer's/tennis elbow) - a review of the recent literature
DOI:
https://doi.org/10.12775/JEHS.2023.17.01.017Keywords
elbow joint stress syndromes, golfer’s elbow, tennis elbow, medial epicondylitis, lateral epicondylitisAbstract
Introduction and Purpose: Tennis elbow and golfer's elbow are two stress syndromes of the elbow joint region which have received much attention due to their effects on everyday and sporting activities. This review intends to provide an up-to-date summary of the pathophysiology, clinical manifestation, diagnostic techniques, and treatment options for the two conditions.
State of Knowledge: Recent research has emphasized the complexity of these diseases, connecting various causes to their emergence. The current study also shows how inflammation, tendon degradation, and neural involvement contribute to these disorders. Imaging advancements, such as ultrasound and MRI, have improved the diagnostic process by allowing visualization and recognition of underlying disorders. To ensure proper management, differential diagnoses, such as nerve compression syndromes and other musculoskeletal diseases, must be carefully evaluated. Rest, physiotherapy, NSAIDs, and corticosteroid injections are important first-line treatments. Novel therapeutic interventions, such as PRP therapy and ESWT have recently been studied as supplements or alternatives to traditional procedures. The exercise-based rehabilitation in controlling and preventing recurrence is also emphasized. Although surgery is reserved for the most difficult cases, advances in minimally invasive techniques have resulted in better outcomes.
Conclusion: Recent literature has significantly contributed to our understanding of elbow stress syndromes. The synthesis of recent research provides clinicians with valuable insights into optimal management strategies. Although, further research is crucial to improve diagnosis, develop new treatments, and raise the standard of care for those affected by these conditions.
References
Verhaar JA. Tennis elbow. Anatomical, epidemiological and therapeutic aspects. Int Orthop. 1994 Oct;18(5):263-7. doi: 10.1007/BF00180221. PMID: 7852001.
Stegink-Jansen CW, Jung B, Somerson JS. Translation of Runge's 1873 publication "On the etiology and treatment of writer's cramp": The first description of "tennis elbow". Clin Anat. 2022 Apr;35(3):316-322. doi: 10.1002/ca.23830. Epub 2022 Jan 7. PMID: 34967051.
Nirschl RP, Ashman ES. Elbow tendinopathy: tennis elbow. Clin Sports Med. 2003 Oct;22(4):813-36. doi: 10.1016/s0278-5919(03)00051-6. PMID: 14560549.
A. Nowakowski, T. Mazurek, Orthopaedics and traumatology textbook for medical students (org. Ortopedia i traumatologia podręcznik dla studentów medycyny), Poznań 2017, str 524
Bożena Targońska-Stępniak, Cezary Stępniak, Maria Majdan, Tendinopathies (org. Tendinopatie), Medycyna po Dyplomie Nr 10 (październik) / 2012
Kraushaar BS, Nirschl RP. Tendinosis of the elbow (tennis elbow). Clinical features and findings of histological, immunohistochemical, and electron microscopy studies. J Bone Joint Surg Am. 1999 Feb;81(2):259-78. PMID: 10073590.
Longo UG, Franceschetti E, Rizzello G, Petrillo S, Denaro V. Elbow tendinopathy. Muscles Ligaments Tendons J. 2012 Sep 10;2(2):115-20. PMID: 23738284; PMCID: PMC3666513.
Alizadehkhaiyat O, Frostick SP. Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis. J Electromyogr Kinesiol. 2015 Dec;25(6):876-86. doi: 10.1016/j.jelekin.2015.10.013. Epub 2015 Oct 28. PMID: 26559462.
Nimura A, Fujishiro H, Wakabayashi Y, Imatani J, Sugaya H, Akita K. Joint capsule attachment to the extensor carpi radialis brevis origin: an anatomical study with possible implications regarding the etiology of lateral epicondylitis. J Hand Surg Am. 2014 Feb;39(2):219-25. doi: 10.1016/j.jhsa.2013.11.036. PMID: 24480683.
Ando R, Arai T, Beppu M, Hirata K, Takagi M. Anatomical study of arthroscopic surgery for lateral epicondylitis. Hand Surg. 2008;13(2):85-91. doi: 10.1142/S021881040800392X. PMID: 19054839.
Qi L, Zhu ZF, Li F, Wang RF. MR imaging of patients with lateral epicondylitis of the elbow: is the common extensor tendon an isolated lesion? PLoS One. 2013 Nov 14;8(11):e79498. doi: 10.1371/journal.pone.0079498. PMID: 24244512; PMCID: PMC3828358.
Ollivierre CO, Nirschl RP. Tennis elbow. Current concepts of treatment and rehabilitation. Sports Med. 1996 Aug;22(2):133-9. doi: 10.2165/00007256-199622020-00006. PMID: 8857707.
Herquelot E, Bodin J, Roquelaure Y, Ha C, Leclerc A, Goldberg M, Zins M, Descatha A. Work-related risk factors for lateral epicondylitis and other cause of elbow pain in the working population. Am J Ind Med. 2013 Apr;56(4):400-9. doi: 10.1002/ajim.22140. Epub 2012 Nov 13. PMID: 23152138.
Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006 Dec 1;164(11):1065-74. doi: 10.1093/aje/kwj325. Epub 2006 Sep 12. PMID: 16968862
Amin NH, Kumar NS, Schickendantz MS. Medial epicondylitis: evaluation and management. J Am Acad Orthop Surg. 2015 Jun;23(6):348-55. doi: 10.5435/JAAOS-D-14-00145. PMID: 26001427.
Wolf JM, Mountcastle S, Burks R, Sturdivant RX, Owens BD. Epidemiology of lateral and medial epicondylitis in a military population. Mil Med. 2010 May;175(5):336-9. doi: 10.7205/milmed-d-09-00086. PMID: 20486505.
Kiel J, Kaiser K. Golfers Elbow. 2022 Jun 27. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30085542.
Alizadehkhaiyat O, Frostick SP. Electromyographic assessment of forearm muscle function in tennis players with and without Lateral Epicondylitis. J Electromyogr Kinesiol. 2015 Dec;25(6):876-86. doi: 10.1016/j.jelekin.2015.10.013. Epub 2015 Oct 28. PMID: 26559462.
Calfee RP, Patel A, DaSilva MF, Akelman E. Management of lateral epicondylitis: current concepts. J Am Acad Orthop Surg. 2008 Jan;16(1):19-29. doi: 10.5435/00124635-200801000-00004. PMID: 18180389.
Brummel J, Baker CL 3rd, Hopkins R, Baker CL Jr. Epicondylitis: lateral. Sports Med Arthrosc Rev. 2014 Sep;22(3):e1-6. doi: 10.1097/JSA.0000000000000024. PMID: 25077751.
Gardner RC. Tennis elbow: diagnosis, pathology and treatment. Nine severe cases treated by a new reconstructive operation. Clin Orthop Relat Res. 1970 Sep-Oct;72:248-53. PMID: 5459792.
Budoff JE, Hicks JM, Ayala G, Kraushaar BS. The reliability of the "Scratch test". J Hand Surg Eur Vol. 2008 Apr;33(2):166-9. doi: 10.1177/1753193408087108. PMID: 18443057.
Polkinghorn BS. A novel method for assessing elbow pain resulting from epicondylitis. J Chiropr Med. 2002 Summer;1(3):117-21. doi: 10.1016/S0899-3467(07)60015-9. PMID: 19674572; PMCID: PMC2646935.
GOLDIE I. EPICONDYLITIS LATERALIS HUMERI (EPICONDYLALGIA OR TENNIS ELBOW). A PATHOGENETICAL STUDY. Acta Chir Scand Suppl. 1964;57:SUPPL 339:1+. PMID: 14192714.
Park GY, Lee SM, Lee MY. Diagnostic value of ultrasonography for clinical medial epicondylitis. Arch Phys Med Rehabil. 2008 Apr;89(4):738-42. doi: 10.1016/j.apmr.2007.09.048. PMID: 18374006.
Miller TT, Shapiro MA, Schultz E, Kalish PE. Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 2002 May;30(4):193-202. doi: 10.1002/jcu.10063. PMID: 11981928.
Levin D, Nazarian LN, Miller TT, O'Kane PL, Feld RI, Parker L, McShane JM. Lateral epicondylitis of the elbow: US findings. Radiology. 2005 Oct;237(1):230-4. doi: 10.1148/radiol.2371040784. Epub 2005 Aug 18. PMID: 16118152.
Miller TT, Shapiro MA, Schultz E, Kalish PE. Comparison of sonography and MRI for diagnosing epicondylitis. J Clin Ultrasound. 2002 May;30(4):193-202. doi: 10.1002/jcu.10063. PMID: 11981928.
Walz DM, Newman JS, Konin GP, Ross G. Epicondylitis: pathogenesis, imaging, and treatment. Radiographics. 2010 Jan;30(1):167-84. doi: 10.1148/rg.301095078. PMID: 20083592.
Steinborn M, Heuck A, Jessel C, Bonel H, Reiser M. Magnetic resonance imaging of lateral epicondylitis of the elbow with a 0.2-T dedicated system. Eur Radiol. 1999;9(7):1376-80. doi: 10.1007/s003300050851. PMID: 10460377.
Savnik A, Jensen B, Nørregaard J, Egund N, Danneskiold-Samsøe B, Bliddal H. Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. Eur Radiol. 2004 Jun;14(6):964-9. doi: 10.1007/s00330-003-2165-4. Epub 2003 Dec 11. PMID: 14669038.
Blazina ME, Kerlan RK, Jobe FW, Carter VS, Carlson GJ. Jumper's knee. Orthop Clin North Am. 1973 Jul;4(3):665-78. PMID: 4783891.
Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL. Current opinions on tendinopathy. J Sports Sci Med. 2011 Jun 1;10(2):238-53. PMID: 24149868; PMCID: PMC3761855.
Smidt N, van der Windt DA, Assendelft WJ, Devillé WL, Korthals-de Bos IB, Bouter LM. Corticosteroid injections, physiotherapy, or a wait-and-see policy for lateral epicondylitis: a randomised controlled trial. Lancet. 2002 Feb 23;359(9307):657-62. doi: 10.1016/S0140-6736(02)07811-X. PMID: 11879861.
Coonrad RW, Hooper WR. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg Am. 1973 Sep;55(6):1177-82. PMID: 4758032.
Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med. 2005 Jul;39(7):411-22; discussion 411-22. doi: 10.1136/bjsm.2004.016170. PMID: 15976161; PMCID: PMC1725258.
Bisset LM, Vicenzino B. Physiotherapy management of lateral epicondylalgia. J Physiother. 2015 Oct;61(4):174-81. doi: 10.1016/j.jphys.2015.07.015. Epub 2015 Sep 8. PMID: 26361816.
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006 Nov;34(11):1774-8. doi: 10.1177/0363546506288850. Epub 2006 May 30. PMID: 16735582.
van Elk N, Faes M, Degens H, Kooloos JG, de Lint JA, Hopman MT. The application of an external wrist extension force reduces electromyographic activity of wrist extensor muscles during gripping. J Orthop Sports Phys Ther. 2004 May;34(5):228-34. doi: 10.2519/jospt.2004.34.5.228. PMID: 15189014.
Groppel JL, Nirschl RP. A mechanical and electromyographical analysis of the effects of various joint counterforce braces on the tennis player. Am J Sports Med. 1986 May-Jun;14(3):195-200. doi: 10.1177/036354658601400303. PMID: 3752358.
Altan L, Kanat E. Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clin Rheumatol. 2008 Aug;27(8):1015-9. doi: 10.1007/s10067-008-0862-8. Epub 2008 Mar 26. PMID: 18365136.
Luginbühl R, Brunner F, Schneeberger AG. No effect of forearm band and extensor strengthening exercises for the treatment of tennis elbow: a prospective randomised study. Chir Organi Mov. 2008 Jan;91(1):35-40. doi: 10.1007/s12306-007-0006-3. Epub 2008 Feb 10. PMID: 18320371.
Pattanittum P, Turner T, Green S, Buchbinder R. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013 May 31;2013(5):CD003686. doi: 10.1002/14651858.CD003686.pub2. PMID: 23728646; PMCID: PMC7173751.
Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W. Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2002;(2):CD003686. doi: 10.1002/14651858.CD003686. Update in: Cochrane Database Syst Rev. 2013;5:CD003686. PMID: 12076503.
Hay EM, Paterson SM, Lewis M, Hosie G, Croft P. Pragmatic randomised controlled trial of local corticosteroid injection and naproxen for treatment of lateral epicondylitis of elbow in primary care. BMJ. 1999 Oct 9;319(7215):964-8. doi: 10.1136/bmj.319.7215.964. PMID: 10514160; PMCID: PMC28251.
Notarnicola A, Moretti B. The biological effects of extracorporeal shock wave therapy (eswt) on tendon tissue. Muscles Ligaments Tendons J. 2012 Jun 17;2(1):33-7. PMID: 23738271; PMCID: PMC3666498.
Pettrone FA, McCall BR. Extracorporeal shock wave therapy without local anesthesia for chronic lateral epicondylitis. J Bone Joint Surg Am. 2005 Jun;87(6):1297-304. doi: 10.2106/JBJS.C.01356. PMID: 15930540.
Razavipour M, Azar MS, Kariminasab MH, Gaffari S, Fazli M. The Short Term Effects of Shock-Wave Therapy for Tennis Elbow: a Clinical Trial Study. Acta Inform Med. 2018;26(1):54-56. doi: 10.5455/aim.2018.26.54-56. PMID: 29719315; PMCID: PMC5869227.
Haake M, König IR, Decker T, Riedel C, Buch M, Müller HH; Extracorporeal Shock Wave Therapy Clinical Trial Group. Extracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial. J Bone Joint Surg Am. 2002 Nov;84(11):1982-91. doi: 10.2106/00004623-200211000-00012. PMID: 12429759.
Raman J, MacDermid JC, Grewal R. Effectiveness of different methods of resistance exercises in lateral epicondylosis--a systematic review. J Hand Ther. 2012 Jan-Mar;25(1):5-25; quiz 26. doi: 10.1016/j.jht.2011.09.001. Epub 2011 Nov 9. PMID: 22075055.
Croisier JL, Foidart-Dessalle M, Tinant F, Crielaard JM, Forthomme B. An isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy. Br J Sports Med. 2007 Apr;41(4):269-75. doi: 10.1136/bjsm.2006.033324. Epub 2007 Jan 15. PMID: 17224433; PMCID: PMC2658962.
Tarpada SP, Morris MT, Lian J, Rashidi S. Current advances in the treatment of medial and lateral epicondylitis. J Orthop. 2018 Feb 2;15(1):107-110. doi: 10.1016/j.jor.2018.01.040. PMID: 29657450; PMCID: PMC5895908.
Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. 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 1-year follow-up. Am J Sports Med. 2010 Feb;38(2):255-62. doi: 10.1177/0363546509355445. PMID: 20448192.
Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014 Feb;42(2):463-71. doi: 10.1177/0363546513494359. Epub 2013 Jul 3. PMID: 23825183.
Buchanan BK, Varacallo M. Tennis Elbow. 2022 Nov 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 28613744.
Kuklo TR, Taylor KF, Murphy KP, Islinger RB, Heekin RD, Baker CL Jr. Arthroscopic release for lateral epicondylitis: a cadaveric model. Arthroscopy. 1999 Apr;15(3):259-64. doi: 10.1016/s0749-8063(99)70031-9. PMID: 10231102.
Nazar M, Lipscombe S, Morapudi S, Tuvo G, Kebrle R, Marlow W, Waseem M. Percutaneous tennis elbow release under local anaesthesia. Open Orthop J. 2012;6:129-32. doi: 10.2174/1874325001206010129. Epub 2012 Apr 2. PMID: 22509230; PMCID: PMC3322435.
Grundberg AB, Dobson JF. Percutaneous release of the common extensor origin for tennis elbow. Clin Orthop Relat Res. 2000 Jul;(376):137-40. doi: 10.1097/00003086-200007000-00019. PMID: 10906868.
Yerger B, Turner T. Percutaneous extensor tenotomy for chronic tennis elbow: an office procedure. Orthopedics. 1985 Oct;8(10):1261-3. doi: 10.3928/0147-7447-19851001-11. PMID: 4094961.
Dunkow PD, Jatti M, Muddu BN. A comparison of open and percutaneous techniques in the surgical treatment of tennis elbow. J Bone Joint Surg Br. 2004 Jul;86(5):701-4. doi: 10.1302/0301-620x.86b5.14469. PMID: 15274267.
Szabo SJ, Savoie FH 3rd, Field LD, Ramsey JR, Hosemann CD. Tendinosis of the extensor carpi radialis brevis: an evaluation of three methods of operative treatment. J Shoulder Elbow Surg. 2006 Nov-Dec;15(6):721-7. doi: 10.1016/j.jse.2006.01.017. Epub 2006 Sep 11. PMID: 16963287.
Peart RE, Strickler SS, Schweitzer KM Jr. Lateral epicondylitis: a comparative study of open and arthroscopic lateral release. Am J Orthop (Belle Mead NJ). 2004 Nov;33(11):565-7. PMID: 15603517.
Sahu RL. Percutaneous golfer's elbow release under local anesthesia: a prospective study. Rev Bras Ortop. 2016;52(3):315-318. Published 2016 Sep 20. doi:10.1016/j.rboe.2016.06.007
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Maciej Zwolski, Krzysztof Puchalski, Konrad Klocek, Aleksandra Hajduk, Łukasz Mrozek, Bartosz Kostecki, Zuzanna Szumlas, Aleksander Jurek, Anna Tekielak
![Creative Commons License](http://i.creativecommons.org/l/by-nc-sa/4.0/88x31.png)
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
The periodical offers access to content in the Open Access system under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
Stats
Number of views and downloads: 712
Number of citations: 0