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Tennis elbow

What is lateral epicondylitis?

Lateral epicondylitis, or tennis elbow, is a disorder characterized by pain on the outside of the elbow at the level of the lateral epicondyle. Patients with this diagnosis suffer from pain in the muscle attachments of the extensors of the lower arm (extensor carpi radialis brevis, extensor carpi ulnaris and extensor digitorum) that becomes worse when the wrist is extended.

It appears that the cause is a stress injury to the tendon connections caused by microscopic rips in the tendon. Tendon tissue is slow to heal, so without sufficient rest, the number of these microscopic rips may increase. At first the body responds to this with a non-bacterial inflammation. Often this inflammation heals and the complaints disappear, but sometimes, the inflammation disappears in the course of time, while the pain remains. The body makes too many undifferentiated tissue cells (fibroblasts) that fail to achieve maturity. The quality of the tendon tissues declines, and in extreme cases the tendon may rip.


The agonist-antagonist principle and dynamics

Holding the wrist in a functional position requires contraction of the painful extensors. These muscles tense even more when something is grasped or lifted with the hand. By having the hand move against resistance in the direction of flexion, the load on the extensors is reduced. This is called the agonist-antagonist principle.1 Moreover, in this way, the extensors are stretched under a minimum load. This stimulates the newly made structures to align themselves with the direction of the load, so that they become stronger more quickly.

1 N. van Elk, M. Faes, H. Degens, J.A. de Lint, J.G.M. Kooloos, M.T.E. Hopman. The application of an external wrist extension force reduces electromyographic activity of wrist extensor muscles during gripping. J. Orthop. Sci. and Phys. Ther., In press, 2004.


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