TENNIS ELBOW (LATERAL EPICONDYLITIS)

• Overuse injury of the hand, especially finger extensor tendons which originate in the lateral humeral epicondyle
• It is caused by activities that involve repetitive wrist extension and /or repetitive forearm supination – pronation with the elbow in near complete extension(e.g. racket sports)
• Characterised by pain and tenderness at the lateral epicondyle of humerus due to non-specific inflammation at the origin of the extensor muscles of the forearm
• Although, it is sometimes seen in tennis players, other activities such as squeezing clothes, carrying suitcase etc. are frequently responsible
• Commonly seen in age group - 40 to 50 years

• Common in tennis players because of repetitive movements that involve bending the wrist in a turning or backward motion
• Workers engaged in repetitive gripping or lifting tasks e.g. painting, hammering, using a screwdriver, house hold activities like squeezing cloth etc.
• Also common in laborer’s who utilize heavy tools
• Patients with lateral epicondylitis have microtears at the common tendinous origin of the extensor muscles in the forearm. This common tendon is attached to the lateral epicondyle of the humerus

• Pain and tenderness in the lateral epicondyle and along extensor muscles
• Pain on movements of the wrist
• Decreased grip strength
• O/E: Point of tenderness- few mm distal to tip of lateral epicondyle

• Cozens test- the test is said to be positive if a resisted wrist extension triggers pain to lateral aspect of the elbow
• Tennis elbow test: examiner holds the patient's hand with the thumb placed over the lateral epicondyle. The patient makes a fist, supinates the forearm, deviates radially, and extends the fist against the examiner's resistance. The test is positive if pain is elicited over the lateral epicondyle 
• X-ray: AP/Lateral of elbow - may reveal calcifications in the extensor muscle mass 
• USG – Tendon thickening

• Rest
• Ice application
• Elbow strap
• Counter-force brace
• NSAIDs
• Physical exercise
• Local injection of hydrocortisone at the point of maximum tenderness

Ayurvedic Treatment

Internal medicines

• Amrutothara Kashaya
• Guggulutikthaka Kashaya
• Rasnasapthaka Kashaya
• Punarnavadi kashaya
• Punarnavasava
• Amrutarishta
• Kanchanara guggulu
• Yogaraja guggulu
• Vettumaran gutika
• Gandha taila

Procedure

• Jalookavacharana / Cupping - Inflammatory conditions
• Lepa - Karuthavattu/ Grihadhoomadi choorna/ Nagaradi choorna
• Lepa – paste of Tila + milk
• Taila Pichu- Murivenna
• Upanaha -Jadamayadi Choorna /Kottamchukkadi Choorna

Chronic stage

• Rookshaswedam
• Agni karma with salaka / madhu/thaila
• Dhara (Local) – Dhanwantara taila