Mechanical solution for a mechanical problem:Tennis elbow

摘要

Lateral epicondylitis is a relatively common clinical prob lem, easily recognized on palpation of the lateral protu berance on the elbow. Despite the "itis" suffix, it is no an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, cortico steroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other ap proaches have included provision of healing cytokine from blood products or stem cells, based on the recog nition that this repetitive effort-derived disorder repre sents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle(enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physi ologic approaches, including manipulation, therapeuti ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, ha also had limited success. This contrasts with the benefi of a simple mechanical intervention, reducing the stres on the attachment area. This is based on displacemen of the stress by use of a thin(3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required as thick bands(e.g., 2-3 inch wide) simply reduce mus cle strength, without significantly reducing stress. Thi approach appears to be associated with a failure rateless than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments.