[G. Homann's operation on the elbow--surgical treatment of a symptom?]

Lateral epicondylopathy, well known as "tennis elbow", sometimes may only be a symptom of cervical spine and shoulder diseases or may also occur in neuropathy or arthropathy of the elbow or wrist joint. A follow-up of 63 patients, four years after Hohmann's procedure, shows that there really exists an idiopathic form of this disease. Careful differential diagnosis and special consideration of the epidemiology is of prime importance if conservative treatment and surgery is to be successful.

Electromyographic analysis of elbow function in tennis players

Muscle activity about the elbow during tennis strokes in nine professional and collegiate level players was studied using indwelling EMG and high speed photography. Eight muscles were evaluated for the serve, forehand, and backhand strokes. The serve was divided into six stages and the ground strokes into four stages. EMG tracings were subjected to analog-to-digital conversion and a relative measure of quantity was obtained. Analysis of variance and Turkey tests were then done to assess statistical significance (P less than 0.05). The ground strokes showed low activity in all muscles tested during the preparation phase. During the acceleration phase, both the backhand and forehand showed a generalized increase in all muscle activity. Both strokes showed marked activity of the wrist extensors and, in addition, the forehand showed high activity in the brachialis and biceps. In the follow-through phase, there was a generalized decrease in muscle activity. The serve showed low activity in all muscles tested during the wind-up phase. The wrist extensors increased their activity in the cooking phase, with marked activity in late cooking. The pronator teres and the triceps showed increased activity in the acceleration phase. Follow-through phase showed low muscle activity except for the biceps, which increased in late follow-through. In conclusion, the muscles of the elbow help stabilize the elbow as a unit during the ground strokes in these high level players. Power in the serve comes from increased activity in the triceps and pronator teres. The predominant activity of the wrist extensors in all strokes may be one explanation for predisposition to injury.

[Polymyography recording in epicondylopathia humeri radialis]

The innervation pattern of arm muscles in tennis elbow during defined movement of the wrist was analysed by polymyography. 30 patients with tennis elbow and 40 control persons had been investigated. Dorsal and palmar movements of the wrist joint lifting 5 kg had been performed. The electromyogram of 8 muscles had been registered. There was no abnormality in palmar flexion. The height and integrals of amplitudes in extensor muscles during extension had been considerably smaller. It is suggested that in tennis elbow the dorsal extension is exerted by a smaller number of fibers. This might be the cause of enthesiopathy.

Tennis elbow, a curable affliction

Forty-five patients with 47 cases of chronic lateral epicondylitis treated surgically were reviewed. Physical examination revealed increased pain with resisted wrist extension, particularly when the elbow was straight. The presence of contracture of the anterolateral elbow capsule at surgery explained the pain with extension. Release of the capsule with the extensors provided relief in 87% of patients. Operative treatment is successful in most cases of chronic tennis elbow when conservative means are exhausted.

Lateral and medial epicondylitis of the elbow

Tennis elbow is a common condition, with the extensor carpi radialis brevis attachment being the usual site of pain. Conservative care including decreased activity, ice, nonsteroidal anti-inflammatory medications, and muscle strengthening will help most people. The small percentage of cases that require surgery usually benefit from debridement of the damaged portion of the extensor carpi radialis brevis attachment. The postoperative course must include muscle strengthening and a gradual return to activity.

Tennis elbow: conservative, surgical, and manipulative treatment

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[Differential diagnosis of epicondylitis humeri radialis]

Intensive amateur sport will lead especially in the untrained to frequent traumatisation. Exact discussion of the symptomatics of the epicondylitis seems to be necessary. Sufficient therapy of various pain symptoms, which are usually described as epicondylitis is only possible after exact differentiation. Paraarticular pain can be caused by the ligamentum-anulare-syndrome as well as by the classic insertion tendinosis. A hypertrophy of the radio-humeral disc can also be the reason of pain after posttraumatic synovitis. Osteoarthritis and rheumatoid arthritis can easily be differentiated from posttraumatic changes by anamnesis and clinical examination. In a large group of patients pain in the elbow region is caused by cervical spine disturbancies, which are frequently overlooked. Similar symptoms can be seen in cases with peripheral irritation of the radial nerve, which can be entrapped as in the supinator syndrome. Juvenile patients can also suffer from osteonecrosis (M. Panner, M. Hegemann) or from epiphysiolysis. In the years from 1975 to 1980 1,096 patients with pain symptoms at the radial epicondyle of the humerus were treated at the Orthopedic Clinic of the University of Vienna under exclusion of those cases with cervical spine disturbancies. Out of the 1,096 patients seen 60 were treated surgically (5,47%) because of insertion tendinosis. 35 cases of osteochondrosis dissecans (3,19%) and three of osteonecrosis (0,27%) were seen in the same period. 60 synovectomies with 33 resections of the radial head were operated because of rheumatoid arthritis with massive destruction of the humeroradial joint.(ABSTRACT TRUNCATED AT 250 WORDS)

[A diagnostic sign in so-called epicondylitis humeri radialis]

With a simple test - the "finger-snapping-test" - it is possible to narrow down the etiology of lateral epicondylalgia of the humerus. On the basis of a group of 196 patients it is shown that a positive result of this test is characteristic for an enthesopathy of the extensor carpi radialis brevis muscle, whose insertion is at the radial epicondyle. If the test is negative it must be assumed that the pain is caused by spondylogenic, arthrogenic, or neurogenic phenomena. The importance of the test for the therapeutic approach and with regard to the indication for operation after Hohmann ist pointed out.

An epidemiological study of lateral epicondylitis (tennis elbow) in amateur male players

Our epidemiological study investigated lateral epicondylitis (tennis elbow) among 150 nonprofessional male tennis players (75% of the players approached consecutively) interviewed and examined physically at four local tennis clubs. The interview and examination covered over sixty possible risk factors, including demographic data, playing habits, anatomical measurements and racket characteristics. The "average" painfree player is 38 years old, has played tennis 11 years, and plays 5.5 hours a week, usually with a racket whose head area is 570 cm2. The "average" tennis elbow sufferer is a 45-year-old player who has been playing 16 years and has played 8 hours weekly before onset of pain with a racket whose head area is 613 cm2. Multivariate analysis indicated that number of playing years has no independent effect beyond its association with age. Playing hours per week, current age and age at pain onset have independent significant effects on number of pain episodes (0-7). Weekly number of playing hours is the best predictor of pain category (none, one or more currently or in the past).

Sports injuries to the upper extremity. How to recognize and deal with some common problems

Upper extremity syndromes caused by a single stress or by repetitive microtrauma occur in a variety of sports. The throwing motion, long-distance swimming, bowling, golf, gymnastics, basketball, volleyball, and field events can repetitively stress the hand, wrist, elbow, and shoulder. The biomechanical evaluation of racquet handling, throwing, and swimming motions has progressed considerably, and the future looks promising for better identification and prevention of sports injuries due to stress. These insights will help the physician more adequately understand and treat athletic injuries. As for the present, we must recognize athletic injuries for what they are--debilitating single or repetitive trauma to active persons who want a rapid return to their sport. The goal of both the injured athlete and the treating physician must be 100% recovery; compromise in treatment is not warranted. To achieve the best results, the physician should emphasize to the athlete, coach, and parent that healing is a matter of time.

Non-articular rheumatism

Non-articular rheumatism is one of the most common afflictions of humankind that arises anywhere in the musculoskeletal system (except the joints). Carefully differentiating non-articular rheumatism from arthritis or the generalized pain syndromes promotes effective management of some of the most common disorders of patients in a physician's practice.