Management of Tennis elbow in racket sports – a literature review

Keywords: Tendinopathy, racket sport, overuse injury, lateral epicondylitis

Abstract

Background: Pain from the lateral aspect of the elbow is a common symptom in racket sports, both in recreational and competitive players. In Tennis elbow (TE), the pain is elicited from the lateral epicondyle and the common extensor origin just distal of the epicondyle. The symptoms are aggravated by gripping activity and might be related to activity level, in work as well as in recreational or elite racket sports. TE is considered to be an overuse injury of degenerative nature and the diagnose is easily made, based on a typical history and clinical findings. Objective: To present current knowledge concerning management of TE in racket sports by a review of the literature. Methods: Narrative literature review. Results: An overview of TE in racket sports with highlight on the clinical features, alternative diagnoses and suggested treatments in the literature. Since TE is considered to be an overuse injury, the paper also provides advises for training plan besides management until resolution of symptoms. Conclusions: This painful condition is self-limiting with a good prognosis. No treatment has convincingly evidence, besides methods for reducing pain symptoms. When the pain symptoms are under control, it is important that the return to racket sports is gradual.

Author Biographies

Martin Fahlström, Umeå University

Department of Clinical Sciences, Professional Development, Umeå University

Eva Zeisig, Umeå University

Department of Surgical and Perioperative Sciences, Orthopaedics, Umeå University

References

Abrams, G. D., Renstrom, P. A., & Safran, M. R. (2012). Epidemiology of musculoskeletal injury in the tennis player. British journal of sports medicine, 46(7), 492-498. https://doi.org/10.1136/bjsports-2012-091164

Bahr, R., Clarsen, B., Derman, W., Dvorak, J., Emery, C. A., Finch, C. F., Hagglund, M., Junge, A., Kemp, S., Khan, K. M., Marshall, S. W., Meeuwisse, W., Mountjoy, M., Orchard, J. W., Pluim, B., Quarrie, K. L., Reider, B., Schwellnus, M., Soligard, T., Stokes, K. A., Timpka, T., Verhagen, E. Bindra, A., Budgett, R., Engebretsen, L., Erdener, U., & Chamari, K. (2020). International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sports 2020 (including the STROBE extension for sports injury and illness surveillance (STROBE-SIIS)). British Journal of Sports Medicine, 54(7), https://doi.org/10.1136/bjsports-2019-101969

Bateman, M., Evans, J. P., Vuvan, V., Jones, V., Watts, A. C., Phadnis, J., Bisset, L., & Vicenzino, B. (2021a). Protocol for the development of a core outcome set for lateral elbow tendinopathy (COS-LET). Trials, 22(1), 1-8. https://doi.org/10.1186/s13063-021-05291-9

Bateman, M., Saunders, B., Littlewood, C., & Hill, J. C. (2021b). Development of an optimised physiotherapist-led treatment protocol for lateral elbow tendinopathy: a consensus study using an online nominal group technique. BMJ open, 11(12), e053841. https://doi.org/10.1136/bmjopen-2021-053841

Berglund, K. M., Persson, B. H., & Denison, E. (2008). Prevalence of pain and dysfunction in the cervical and thoracic spine in persons with and without lateral elbow pain. Manual therapy, 13(4), 295-299. https://doi.org/10.1016/j.math.2007.01.015

Bisset, L., Beller, E., Jull, G., Brooks, P., Darnell, R., & Vicenzino, B. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ, 333(7575), 939. https://doi.org/10.1136/bmj.38961.584653.AE

Bisset, L., Coombes, B., & Vicenzino, B. (2011). Tennis elbow. BMJ clinical evidence, 2011, 1117. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217754/

Brosseau, L., Casimiro, L., Milne, S., Welch, V., Shea, B., Tugwell, P., & Wells, G. A. (2002). Deep transverse friction massage for treating tendinitis. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD003528

Buchbinder, R., Green, S., Youd, J. M., Assendelft, W. J., Barnsley, L., & Smidt, N. (2005). Shock wave therapy for lateral elbow pain. Cochrane Database of Systematic Reviews, (4). https://doi.org/10.1002/14651858.CD003524.pub2

Buchbinder, R., Johnston, R. V., Barnsley, L., Assendelft, W. J., Bell, S. N., & Smidt, N. (2011). Surgery for lateral elbow pain. Cochrane Database of Systematic Reviews, (3). https://doi.org/10.1002/14651858.CD003525.pub2

Caine, D., Harmer, P., & Schiff, M. (2010). Epidemiology of injury in Olympic sports. The encyclopaedia of sports medicine. An IOC Medical Commission publication. Oxford, England: Blackwell Publishing, Ltd. https://stillmed.olympic.org/media/Document%20Library/OlympicOrg/IOC/Who-We-Are/Commissions/Medical-and-Scientific-Commission/Encyclopaedia/2010_Caine.pdf

Castillo-Lozano, R., & Casuso-Holgado, M. J. (2016). Incidence of musculoskeletal sport injuries in a sample of male and female recreational paddle-tennis players. The Journal of sports medicine and physical fitness, 57(6), 816-821. https://doi.org/10.23736/s0022-4707.16.06240-x

Chourasia, A. O., Buhr, K. A., Rabago, D. P., Kijowski, R., Lee, K. S., Ryan, M. P., Grettie-Belling, J. & Sesto, M. E. (2013). Relationships between biomechanics, tendon pathology, and function in individuals with lateral epicondylosis. Journal of orthopaedic & sports physical therapy, 43(6), 368-378. https://doi.org/10.2519/jospt.2013.4411

Claessen, F. M., Heesters, B. A., Chan, J. J., Kachooei, A. R., & Ring, D. (2016). A meta-analysis of the effect of corticosteroid injection for enthesopathy of the extensor carpi radialis brevis origin. The Journal of hand surgery, 41(10), 988-998. https://doi.org/10.1016/j.jhsa.2016.07.097

Clarke, A. W., Ahmad, M., Curtis, M., & Connell, D. A. (2010). Lateral elbow tendinopathy: correlation of ultrasound findings with pain and functional disability. The American journal of sports medicine, 38(6), 1209-1214. https://doi.org/10.1177/0363546509359066

Coombes, B. K., Bisset, L., & Vicenzino, B. (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. The Lancet, 376(9754), 1751-1767. https://doi.org/10.1016/S0140-6736(10)61160-9

Coombes, B. K., Bisset, L., Brooks, P., Khan, A., & Vicenzino, B. (2013). Effect of corticosteroid injection, physiotherapy, or both on clinical outcomes in patients with unilateral lateral epicondylalgia: a randomized controlled trial. JAMA, 309(5), 461-469. https://doi.org/10.1001/jama.2013.129

De Smedt, T., de Jong, A., Van Leemput, W., Lieven, D., & Van Glabbeek, F. (2007). Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. British journal of sports medicine, 41(11), 816-819. https://doi.org/10.1136/bjsm.2007.036723

Dines, J. S., Bedi, A., Williams, P. N., Dodson, C. C., Ellenbecker, T. S., Altchek, D. W., Windler, G., & Dines, D. M. (2015). Tennis injuries: epidemiology, pathophysiology, and treatment. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 23(3), 181-189. https://doi.org/10.5435/JAAOS-D-13-00148

Franchini, M., Cruciani, M., Mengoli, C., Marano, G., Pupella, S., Veropalumbo, E., Masiello, F., Pati, I., Vaglio, S. & Liumbruno, G. M. (2018). Efficacy of platelet-rich plasma as conservative treatment in orthopaedics: a systematic review and meta-analysis. Blood Transfusion, 16(6), 502. https://doi.org/10.2450/2018.0111-18

Gijon-Nogueron, G., Ortega-Avila, A. B., Kaldau, N. K., Fahlstrom, M., Felder, H., Kerr, S., King, M., McCaig, S., Marchena-Rodriquez, A., & Cabello-Manrique, D. (2022). Data collection procedures and injury definitions in badminton: A consensus statement according to the Delphi approach. Clinical Journal of Sport Medicine. https://doi.org/10.1097/JSM.0000000000001048

Hoogvliet, P., Randsdorp, M. S., Dingemanse, R., Koes, B. W., & Huisstede, B. M. (2013). Does effectiveness of exercise therapy and mobilisation techniques offer guidance for the treatment of lateral and medial epicondylitis? A systematic review. British journal of sports medicine, 47(17), 1112-1119. https://bjsm.bmj.com/content/47/17/1112.citation-tools

Horsley, I., O’Donnell, V., & Leeder, J. (2020). The epidemiology of injuries in English professional squash; A retrospective analysis between 2004 and 2015. Physical therapy in sport, 46, 1-6. https://doi.org/10.1016/j.ptsp.2020.07.009

Hume, P. A., Reid, D., & Edwards, T. (2006). Epicondylar injury in sport: Epidemiology, Type, Mechanisms, Assessment, Management and Prevention. Sports medicine, 36(2), 151-170. https://doi.org/10.2165/00007256-200636020-00005

Kim, Y. J., Wood, S. M., Yoon, A. P., Howard, J. C., Yang, L. Y., & Chung, K. C. (2021). Efficacy of nonoperative treatments for lateral epicondylitis: a systematic review and meta-analysis. Plastic and Reconstructive Surgery, 147(1), 112-125. https://doi.org/10.1097/PRS.0000000000007440

King, M. A., Kentel, B. B., & Mitchell, S. R. (2012). The effects of ball impact location and grip tightness on the arm, racquet and ball for one-handed tennis backhand groundstrokes. Journal of Biomechanics, 45(6), 1048-1052. https://doi.org/10.1016/j.jbiomech.2011.12.028

Kotnis, N. A., Chiavaras, M. M., & Harish, S. (2012). Lateral epicondylitis and beyond: imaging of lateral elbow pain with clinical-radiologic correlation. Skeletal radiology, 41(4), 369-386. https://doi.org/10.1007/s00256-011-1343-8

Kraushaar, B. S., & Nirschl, R. P. (1999). Tendinosis of the elbow (tennis elbow): clinical features and findings of histological, immunohistochemical, and electron microscopy studies. Journal of Bone and Joint Surgery, 81(2), 259-278. https://www.proquest.com/openview/8ae7310b439893743b447bbd3b9d909d/1?pq-origsite=gscholar&cbl=289

Kroslak, M., Pirapakaran, K., & Murrell, G. A. (2019). Counterforce bracing of lateral epicondylitis: a prospective, randomized, double-blinded, placebo-controlled clinical trial. Journal of shoulder and elbow surgery, 28(2), 288-295. https://doi.org/10.1016/j.jse.2018.10.002

Lattermann, C., Romeo, A. A., Anbari, A., Meininger, A. K., McCarty, L. P., Cole, B. J., & Cohen, M. S. (2010). Arthroscopic debridement of the extensor carpi radialis brevis for recalcitrant lateral epicondylitis. Journal of shoulder and elbow surgery, 19(5), 651-656. https://doi.org/10.1016/j.jse.2010.02.008

Lawrence, T., Mobbs, P., Fortems, Y., & Stanley, J. K. (1995). Radial tunnel syndrome: A retrospective review of 30 decompressions of the radial nerve. Journal of Hand Surgery, 20(4), 454-459. https://doi.org/10.1016/S0266-7681(05)80152-4

Lenoir, H., Mares, O., & Carlier, Y. (2019). Management of lateral epicondylitis. Orthopaedics & Traumatology: Surgery & Research, 105(8), S241-S246. https://doi.org/10.1016/j.otsr.2019.09.004

Maffulli, N., Regine, R., Carrillo, F., Capasso, G., & Minelli, S. (1990). Tennis elbow: an ultrasonographic study in tennis players. British Journal of Sports Medicine, 24(3), 151-155. https://doi.org/10.1136/bjsm.24.3.151

Naam, N. H., & Nemani, S. (2012). Radial tunnel syndrome. Orthopedic Clinics, 43(4), 529-536. https://doi.org/10.1016/j.ocl.2012.07.022

Nirschl, R. P. (1992). Elbow tendinosis/tennis elbow. Clinics in sports medicine, 11(4), 851-870. https://europepmc.org/article/med/1423702

Obradov, M., & Anderson, P. G. (2012). Ultrasonographic findings for chronic lateral epicondylitis. Jbr-btr, 95(2), 66-70. https://www.jbsr.be/articles/88/galley/85/download/

Placzek, R., Drescher, W., Deuretzbacher, G., Hempfing, A., & Meiss, A. L. (2007). Treatment of chronic radial epicondylitis with botulinum toxin A: a double-blind, placebo-controlled, randomized multicenter study. JBJS, 89(2), 255-260. https://doi.org/10.2106/JBJS.F.00401

Ravalli, S., Pulici, C., Binetti, S., Aglieco, A., Vecchio, M., & Musumeci, G. (2019). An overview of the pathogenesis and treatment of elbow osteoarthritis. Journal of Functional Morphology and Kinesiology, 4(2), 30. https://doi.org/10.3390/jfmk4020030

Sanders, T. L., Maradit Kremers, H., Bryan, A. J., Ransom, J. E., Smith, J., & Morrey, B. F. (2015). The epidemiology and health care burden of tennis elbow: a population-based study. The American journal of sports medicine, 43(5), 1066-1071. https://doi.org/10.1177/0363546514568087

Savnik, A., Jensen, B., Nørregaard, J., Egund, N., Danneskiold-Samsøe, B., & Bliddal, H. (2004). Magnetic resonance imaging in the evaluation of treatment response of lateral epicondylitis of the elbow. European radiology, 14(6), 964-969. https://doi.org/10.1007/s00330-003-2165-4

Shiri, R., & Viikari-Juntura, E. (2011). Lateral and medial epicondylitis: role of occupational factors. Best practice & research Clinical rheumatology, 25(1), 43-57. https://doi.org/10.1016/j.berh.2011.01.013

Smidt, N., & van der Windt, D. A. (2006). Tennis elbow in primary care. BMJ, 333(7575), 927-928. https://doi.org/10.1136/bmj.39017.396389.BE

Solheim, E., Hegna, J., & Øyen, J. (2013). Arthroscopic versus open tennis elbow release: 3-to 6-year results of a case-control series of 305 elbows. Arthroscopy: The journal of Arthroscopic & Related Surgery, 29(5), 854-859. https://doi.org/10.1016/j.arthro.2012.12.012

Struijs, P. A., Smidt, N., Arola, H., Van Dijk, C. N., Buchbinder, R., & Assendelft, W. J. (2001). Orthotic devices for tennis elbow: a systematic review. British Journal of General Practice, 51(472), 924-929. https://bjgp.org/content/bjgp/51/472/924.full.pdf

Taylor, S. A., & Hannafin, J. A. (2012). Evaluation and management of elbow tendinopathy. Sports Health, 4(5), 384-393. https://doi.org/10.1177/1941738112454651

Villaseñor-Ovies, P., Vargas, A., Chiapas-Gasca, K., Canoso, J. J., Hernández-Díaz, C., Saavedra, M. Á., Navarro, J., & Kalish, R. A. (2012). Clinical anatomy of the elbow and shoulder. Reumatologia clinica, 8, 13-24. https://doi.org/10.1016/j.reuma.2012.10.009

Walker-Bone, K., Palmer, K. T., Reading, I., Coggon, D., & Cooper, C. (2012). Occupation and epicondylitis: a population-based study. Rheumatology, 51(2), 305-310. https://doi.org/10.1093/rheumatology/ker228

Zeisig, E. (2012). Natural course in tennis elbow—lateral epicondylitis after all?. Knee Surgery, Sports Traumatology, Arthroscopy, 20(12), 2549-2552. https://doi.org/10.1007/s00167-012-1939-0

Zeisig, E., Ljung, B. O., Alfredson, H., & Danielson, P. (2009). Immunohistochemical evidence of local production of catecholamines in cells of the muscle origins at the lateral and medial humeral epicondyles: of importance for the development of tennis and golfer’s elbow?. British Journal of Sports Medicine, 43(4), 269-275. https://bjsm.bmj.com/content/43/4/269

Zeisig, E., Öhberg, L., & Alfredson, H. (2006). Extensor origin vascularity related to pain in patients with tennis elbow. Knee Surgery, Sports Traumatology, Arthroscopy, 14(7), 659-663. https://doi.org/10.1007/s00167-006-0060-7

Published
2022-06-30
How to Cite
Fahlström, M., & Zeisig, E. (2022). Management of Tennis elbow in racket sports – a literature review. International Journal of Racket Sports Science, 4(1), 25-31. https://doi.org/10.30827/Digibug.77268