title: Lateral epicondylalgia: midlife crisis of a tendon.
abstract: The pathogenesis and management of lateral epicondylalgia, or tennis elbow, a common ailment affecting middle-aged subjects of both genders continue to provoke controversy. Currently it is thought to be due to local tendon pathology, pain system changes, and motor system impairment. Its diagnosis is usually clinical, based on a classical history, as well as symptoms and signs. In selected cases, additional imaging (X-rays, ultrasound, and magnetic resonance imaging) can help to confirm the diagnosis. Different treatment modalities have been described, including the use of orthotics, non-steroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery. Nevertheless, evidence to select the best treatment is lacking and the choice of therapy depends on the experience of the management team, availability of the equipment and expertise, and patient response. This article provides a snapshot of current medical practice for lateral epicondylalgia management.
authors.affiliation: Department of Medicine and Geriatrics, Fung Yiu King Hospital, 9 Sandy Bay Road, Pokfulam, Hong Kong.
authors.forename: James K H
authors.initials: JK
authors.lastname: Luk
authors.affiliation: Physiotherapy Department, MacLehose Medical Rehabilitation Centre, 7 Sha Wan Drive, Pokfulam, Hong Kong.
authors.forename: Raymond C C
authors.initials: RC
authors.lastname: Tsang
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong.
authors.forename: H B
authors.initials: HB
authors.lastname: Leung
mesh_terms: D015670:Acupuncture Therapy; D000287:Administration, Topical; D055052:Athletic Tape; D001905:Botulinum Toxins / Q000627:therapeutic use; D001915:Braces; D005081:Exercise Therapy; D005938:Glucocorticoids / Q000627:therapeutic use; D019220:High-Energy Shock Waves; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use; D007270:Injections, Intra-Articular; D053685:Laser Therapy; D008405:Massage; D053580:Muscle Strength / Q000502:physiology; D009498:Neurotoxins / Q000627:therapeutic use; D005996:Nitroglycerin / Q000627:therapeutic use; D019637:Orthopedic Procedures; D058748:Pain Perception / Q000502:physiology; D010808:Physical Examination / Q000379:methods; D053657:Platelet-Rich Plasma; D013716:Tennis Elbow / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D014464:Ultrasonic Therapy; D014665:Vasodilator Agents / Q000627:therapeutic use; D055675:Viscosupplements / Q000627:therapeutic use
chemical_list: D005938:Glucocorticoids; D009498:Neurotoxins; D014665:Vasodilator Agents; D055675:Viscosupplements; D006820:Hyaluronic Acid; D001905:Botulinum Toxins; D005996:Nitroglycerin
keywords: Middle aged; Tendons; Tennis elbow/rehabilitation