The Elbow and Tennis, Part 1: An Analysis of Players With and Without Pain

Elbow, wrist kinematics and shock transmission of backhand stroke in wheelchair tennis players

The aim was to compare the differences in kinematics of elbow and wrist and shock transmission of the upper extremity in wheelchair tennis players and able-bodied players (in standing and sitting position) during backhand strokes. Fifteen wheelchair tennis and 15 able-bodied tennis players enrolled. Electromagnetic system and trial-axial accelerometers were used to measure the difference in the kinematic parameters of the upper extremity and the impact vibration transferred across the wrist joint. The results indicated that wheelchair players demonstrated unique elbow and wrist kinematics, especially shorter total swing time, greater elbow flexion at preparation, lower wrist extension acceleration before impact, and smaller racket vibration at impact. Comparing to able-bodied players in standing, wheelchair players and players in sitting demonstrated significantly greater elbow joint flexion/extension angle, angular velocity, angular acceleration during extension, and wrist joint flexion angle. Wheelchair players also differ significantly with the players in sitting regarding elbow joint angular velocity and acceleration, and wrist joint flexion velocity. These adaptations and adjustments can be attributed to the missing lower extremity function and deficient trunk kinetic chain. The differences between wheelchair tennis players and able-bodied players in sitting could represent the progress as the wheelchair players moving from novices to experts.

Step by Step Guide to Understanding the Kinetic Chain Concept in the Overhead Athlete

PURPOSE OF REVIEW

The purpose of this review will be to provide both a historical and recent review of the role of the kinetic chain for the overhead athlete. The kinetic chain concept will then be applied to clinical exercise modifications and integrations for prevention and treatment of shoulder injury.

RECENT FINDINGS

The primary conclusion reached through this review is the important role the lower extremity, trunk, and scapular region play in the development of optimal terminal segment acceleration in the overhead throwing and serving motion. Failure of any links in the kinetic chain has implications for shoulder and elbow injury in the overhead athlete. Modifications of traditional shoulder exercises emphasizing activation of the scapular stabilizers and core musculature alongside concomitant rotator cuff activation are recommended and supported in EMG research. Future research is needed to further identify risk factors and rehabilitation and prevention strategies and key clinical tests for the overhead athlete. The goal is to elucidate the important role the kinetic chain plays in both performance enhancement and injury prevention for the overhead athlete. Understanding the key role all segments of the kinetic chain play in the complex biomechanical segmental rotations required for high-level throwing and serving will assist clinicians who work with overhead athletes.

Long-term follow-up of platelet-rich plasma injections for refractory lateral epicondylitis

Background

Lateral epicondylitis (LE)¹ affects between 1 and 3% of the population. Recently, platelet-rich plasma (PRP)² has gained popularity.

Aim

Assess the long-term outcomes of PRP for patients with refractory LE.

Methods

We assessed 31 patients who had failed conservative management using the Oxford Elbow Score (OES).³.

Results

Mean follow-up: 5.2 years (range 4.2-6.1 years).87.1% exhibited minimum clinically important difference (MCID)⁴ in pain scores between pre-op and long-term. 90.3% displayed MCID in function and psycho-social domains.Two patients had a repeat injection and six underwent open release.

Discussion

PRP is successful in treating refractory LE in most patients and avoiding surgery.

Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review

The objective was to systematically review the literature on risk factors and prevention programs for musculoskeletal injuries among tennis players. PubmedMedline, Embase, CINAHL, Cochrane, SportDiscus were searched up to February 2017. Experts in clinical and epidemiological medicine were contacted to obtain additional studies. For risk factors, prospective cohort studies (n > 20) with a statistical analysis for injured and non-injured players were included and studies with a RCT design for prevention programs. Downs&Black checklist was assessed for risk of bias for risk factors. From a total of 4067 articles, five articles met our inclusion criteria for risk factors. No studies on effectiveness of prevention programs were identified. Quality of studies included varied from fair to excellent. Best evidence synthesis revealed moderate evidence for previous injury regardless of body location in general and fewer years of tennis experience for the occurrence of upper extremity injuries. Moderate evidence was found for lower back injuries, a previous back injury, playing >6hours/week and low lateral flexion of the neck for risk factors. Limited evidence was found for male gender as a risk factor. The risk factors identified can assist clinicians in developing prevention-strategies. Further studies should focus on risk factor evaluation in recreational adult tennis players.

Effectiveness of a Custom-Made below Elbow Lateral Counterforce Splint in the Treatment of Lateral Epicondylitis (Tennis Elbow)

The purpose of the study was to determine the effectiveness of a custom-made below elbow lateral counterforce splint along with standard physiotherapy compared with physiotherapy alone, for the treatment of lateral epicondylitis. It was hypothesized that the recovery from lateral epicondylitis is greater following four weeks of standard physiotherapy and the use of the splint, than following four weeks of standard physiotherapy alone. The experimental group (with the splint and physiotherapy) demonstrated a significant improvement in pain (p = 0.05) and maximum grip strength (p = 0.025) of the affected arm compared to the control group. The experimental group showed a greater improvement in function approaching but not reaching significance. The results indicate that this custom-made splint is of value in facilitating the recovery from lateral epicondylitis.

Lateral epicondylitis of the elbow

Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches.

Upper limb muscle imbalance in tennis elbow: a functional and electromyographic assessment

The purpose of this study was to investigate strength, fatigability, and activity of upper limb musculature to elucidate the role of muscular imbalance in the pathophysiology of tennis elbow. Sixteen patients clinically diagnosed with tennis elbow, recruited from a university hospital upper limb orthopedic clinic, were compared with 16 control subjects with no history of upper limb musculoskeletal problem, recruited from university students and staff. Muscle strength was measured for grip, metacarpophalangeal, wrist, and shoulder on both sides. Electromyographic activity (RMS amplitude) and fatigue characteristics (median frequency slope) of five forearm and two shoulder muscles were measured during isometric contraction at 50% maximum voluntary contraction. All strength measurements showed dominance difference in C, but none in TE. In tennis elbow compared to controls, hand/wrist and shoulder strength and extensor carpi radialis (ECR) activity were reduced (p < 0.05), while fatigue was normal. A global upper limb weakness exists in tennis elbow. This may be due to disuse and deconditioning syndrome caused by fear avoidance, and needs to be addressed in prevention and treatment. Activation imbalance among forearm muscles (reduced extensor carpi radialis activity) in tennis elbow, probably due to protective pain-related inhibition, could lead to a widespread upper limb muscle imbalance.

Influence of racket properties on injuries and performance in tennis

Racket properties may affect tennis elbow development. Shock and vibration to the arm is influenced by the location of ball impacts on the racket head, racket stiffness, and grip force. Beginners experience increased arm loads, and they hit the ball lower on the racket head. Tennis rackets behave differently during actual play compared with the performance predicted by physics.

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention

Epicondylar injuries in sports with overhead or repetitive arm actions are frequent and often severe. Acute injury that results in inflammation should be termed epicondylitis and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon. Epicondylalgia refers to elbow pain at either the medial or lateral epicondyl of the elbow related to tendinopathy of the common flexor or extensor tendon origins at these points. Pain is usually associated with gripping, resisted wrist extension and certain movements such as in tennis and golf, hence the common terms 'tennis elbow' (lateral epicondylsis) and 'golf elbow' (medial epicondylossi). A variety of assessment and diagnostic tools are available to aid the clinician in their comprehensive evaluation of the patient to ensure correct diagnosis and the appropriate conservative or surgical management strategy. Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. Medical practitioners should have a good understanding of the mechanisms of injury in order to help treat and prevent the re-occurrence of injuries. More emphasis by medical and sport science personnel working with coaches and athletes needs to be placed on prevention of elbow injury in sport through improved joint strength, biomechanically sound sport technique and use of appropriate sport equipment.

Tennis injuries: occurrence, aetiology, and prevention

A systematic search of published reports was carried out in three electronic databases from 1966 on to identify relevant articles relating to tennis injuries. There were 39 case reports, 49 laboratory studies, 28 descriptive epidemiological studies, and three analytical epidemiological studies. The principal findings of the review were: first, there is a great variation in the reported incidence of tennis injuries; second, most injuries occur in the lower extremities, followed by the upper extremities and then the trunk; third, there have been very few longitudinal cohort studies that investigated the association between risk factors and the occurrence of tennis injuries (odds ratios, risk ratios, hazard ratios); and fourth, there were no randomised controlled trials investigating injury prevention measures in tennis. More methodologically sound studies are needed for a better understanding of risk factors, in order to design useful strategies to prevent tennis injuries.

Biomechanical evaluation of braces used for the treatment of epicondylitis

The purpose of the study was to investigate the biomechanical effects of different types of braces that are used in the treatment of patients with epicondylitis radialis. Vibration and acceleration of the forearm and the elbow were measured with sensors taped to defined anatomic points on the skin surface. The impact-induced vibration of the racket-arm system was analyzed while the subjects were playing tennis. Different designed brace systems were investigated with respect to acceleration amplitudes and acceleration integrals. Clasp-based brace systems showed a slight reduction of acceleration amplitudes (-6%) and acceleration integrals (-8%). Braces with pads at the lateral epicondyle reduced acceleration amplitudes by 20% and acceleration integrals by 22%. Braces with pads placed at the forearm showed the highest reduction of acceleration amplitudes (-46%) and acceleration integrals (-42%). Overload of the wrist extensors, which is considered to be a major pathogenic factor in lateral epicondylitis, can be reduced by braces. There is a significant difference in the effects among different biomechanical principles of braces.

Elbow injuries

The elbow is a commonly injured joint, yet physicians may be less comfortable treating injuries to the elbow compared with knee and shoulder injuries. Common injuries involving the elbow are tendinosis, instability, tendon ruptures, osteochondritis dissecans, and fractures. Tendinosis is a common overuse injury and may occur on the lateral, medial, or infrequently, the posterior side of the elbow. Injury to the medial or lateral ulnar collateral ligaments may result in instability. Repetitive trauma from overuse is the most common etiologic factor in athletes. Distal biceps and triceps tendon injuries may result in elbow disability in active individuals. Partial tears are more difficult to diagnose than complete ruptures. Osteochondritis dissecans of capitellum affects adolescents involved in overhead throwing athletics. Fractures about the elbow most commonly involve the radial head in adults, and the distal humerus in children. Athletes are prone to elbow injuries resulting from both overuse and acute trauma. Our purpose is to describe the diagnosis and treatment of these common elbow injuries in athletes of all ages.

Lateral epicondylitis

Satisfactory treatment of lateral epicondylitis results from correct diagnosis followed by a well-controlled operative or nonoperative treatment program. Many options for nonoperative and operative treatment exist for lateral epicondylitis. More study is needed on outcomes of both nonoperative treatment and operative treatment so that each patient can attain maximal improvement. Balanced assessments of specific patient populations, along with definitions of the optimal treatment for each group, are required. This will allow physicians to integrate the available information and improve patient care.

The elbow

Elbow disorders in the athletic population comprise a wide range of injuries from acute trauma to those caused by chronic overuse of the joint. Certain injuries are orthopedic emergencies that must be recognized immediately by the team physician to avoid potential complications. Other overuse injuries need to be accurately diagnosed and treated so further injury can be prevented and the athlete can return to competition as expediently as possible. Finally, the decision to refer an athlete for surgical treatment often rests with the team physician; only with an adequate understanding of the elbow disorders in the athlete can these decisions be made.

High prevalence of elbow problems among goalkeepers in European team handball -- 'handball goalie's elbow'

The aim of this study was to describe elbow problems among goalkeepers in team handball. A questionnaire was sent to the coaches of 449 senior and 32 junior teams in Norway in 1992. Of these, 304 coaches responded (63%) and their teams were included in the study. A total of 329 out of 729 goalkeepers (45+/-1.8%) and 166 out of 4120 court players (4.0+/-0.3%) were reported by their coaches to have current or previous symptoms from one or both elbows when playing handball. In response to a second questionnaire sent to all the goalkeepers (729; response rate 81%), 41+/-2.0% reported current elbow problems and an additional 34+/-2.0% reported previous problems. During a 2-year observation period from 1992 to 1994, 8.6+/-1.8% of the goalkeepers with previously healthy elbows experienced elbow problems. The typical complaint was recurrent pain and disability episodes, each with an acute onset, but with varying duration. The mechanism of injury for the goalkeepers appears to be repeated hyperextension traumas. We conclude that elbow pain and disability is a significant problem for a large number of goalkeepers in team handball. These problems may be described as a syndrome called 'handball goalie's elbow'.

A comparison of the high and low backspin backhand drives in tennis using different grips

Three-dimensional, high-speed cinematography was used to compare backspin backhand techniques of high performance players hitting low (5.4 cm below hip height) and high (41.6 cm above hip height) bouncing balls using their preferred method of holding the racket (eastern backhand or continental grip: hand generally on top of the handle) and non-preferred ('behind the handle') grip. The Direct Linear Transformation method was used for three-dimensional space reconstruction from two-dimensional images recorded from laterally placed phase-locked cameras operating at 200 Hz. The only significant differences (P < 0.05) caused by the change in grip were that the ball was impacted further in front of the body when using the non-preferred grip, and a lower peak racket-shoulder speed was recorded for a high bouncing ball when using the non-preferred grip. Irrespective of the type of grip, the players significantly modified (P < 0.01) their technique to hit a high bouncing ball by adopting a more upright trunk, more rotated shoulder alignment (racket shoulder pointing more towards opponent), a larger front knee angle and a more abducted upper arm. Hitting a high ball was also characterized by a less inclined approach trajectory of the racket, a more vertical racket-face and a different speed profile for the segments of the upper limb and racket.

Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes

It is generally believed that tennis players using a double-handed backhand rarely develop lateral epicondylitis since the helping arm appears to absorb more energy and changes the mechanics of the swing. The purpose of this paper was to compare muscle activity about the elbow in single- and double-handed backhand strokes in competitive tennis players. Muscle activity in 3 elbow extensors, a wrist flexor, and a forearm pronator of the dominant arm was compared during the single-handed (N = 14) and double-handed (N = 13) backhand ground strokes using indwelling electromyography and high-speed cinematography. Significantly higher activity was seen in the double-handed technique in the flexor carpi radialis muscle in the preparation phase and in the pronator teres muscle in the acceleration phase. Higher flexor carpi radialis muscle activity in preparation of the double-handed stroke appeared to be a function of the double-handed grip used on the racquet, and the increased pronator teres muscle activity in acceleration indicated maintenance of greater pronation provided by the grip of the non-dominant hand. The decreased occurrence of lateral epicondylitis in players using a double-handed backhand may not be caused by decreased extensor activity, but rather by factors associated with flawed stroke mechanics more often seen in the single-handed technique.

Forces on the Hand in the Tennis One-Handed Backhand

This study examined the pattern of forces and peak loads on the hands of six advanced and six intermediate level male tennis players as they performed one-handed backhand drives. Two miniature load cells were mounted on a midsized graphite racket. The force on the thenar and hypothenar eminences of the hand were sampled at 1000 Hz. Forces on the thenar eminence in preparation for impact were significantly larger and less variable for the advanced subjects. Postimpact peak forces did not differ across skill level and were smaller than the loads reported for forehand drives. The significantly lower thenar forces the intermediate subjects used in preparation for impact may provide less resistance to the acceleration of the racket created by ball impact. A large impact acceleration may be related to a rapid stretch of the wrist extensors, which has been hypothesized to be the cause of tennis elbow.

Ultrasound catheter placement for deep posterior compartment pressure measurements in chronic compartment syndrome

Medial shin pain, often referred to as shin splints, is a common but difficult to diagnose entity in many athletes. Chronic deep posterior compartment syndrome as a cause of medial leg pain is still controversial. The problems of deep posterior compartment pressure measurement contribute to this controversy. These problems include safety of catheter insertion and the possibility that the patient has more than one deep posterior compartment. In this paper, we present a new technique for catheter placement in which continuous ultrasound guidance is used. This technique allows for the safe placement of the catheter into the deep posterior compartment and for documentation of catheter tip location.

The use of magnetic resonance imaging in exertional compartment syndromes

This prospective, double-blind study was carried out to assess the usefulness of magnetic resonance imaging (MRI) as a noninvasive method in the diagnosis of chronic compartment syndrome (CCS). As well, a new radiopharmaceutical known as methoxy isobutyl isonitrile that has been shown to be taken up by muscle in direct proportion to its blood flow was used to illustrate the possible pathophysiology of this syndrome. Twenty patients with a history of chronic leg pain and possible diagnosis of CCS and five normal volunteers had preexercise and postexercise MRI, nuclear medicine imaging, and static and dynamic slit catheter pressure studies. Nine patients had classic symptoms; only five of these nine had abnormal pressure studies. The other 11 patients had an element of pain at rest and had normal pressure studies. The nuclear blood flow studies were normal in all 25 legs tested in this study. Measurement of intrinsic MRI parameters T1 and T2 in the normal legs as well as in those with an atypical history showed a marked elevation with exercise and a gradual return to baseline postexercise that was similar to the pressure curves. In the five patients with a clinical history and elevated pressures, four had abnormal MRI studies with failure of T1 to return to baseline values. Although these results demonstrate the potential of MRI as a tool for noninvasively monitoring muscle status, clinical history and examination remain important in the diagnosis of CCS. This study indicates that the pathophysiology of exertional compartment syndrome does not appear to be related to ischemia.

Effect of standard and Aircast tennis elbow bands on integrated electromyography of forearm extensor musculature proximal to the bands

Classic tennis elbow, or lateral epicondylitis, has been described as an overuse or misuse injury resulting in a tendinitis. The extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) have been implicated as primary culprits in this pathology. Tennis elbow has been treated using a constrictive band placed several centimeters distal to the origin of these two muscles. Aircast (Aircast Inc., Summit, NJ) has developed a new style of band that employs an air-filled bladder as the counterpressure element. This study tested the effect of both standard and Aircast bands on EMG activity of the EDC and ECRB proximal to the band compared to control values. Ten normal subjects, ranging in age from 20 to 43 years, were tested. Right upper extremities were tested in all cases. The subjects' forearms were stabilized in the CYBEX II forearm stabilization V-pad. The ECRB and EDC were then impaled with monopolar EMG needle electrodes. The CYBEX data were recorded using the HUMAC system and the EMG data were recorded and analyzed using the Cadwell 7400. EMG data were recorded at 80% of maximum voluntary isometric contraction (MVIC) with no band, the standard band, and the Aircast band. An analysis of variance (ANOVA) with repeated measures of integrated EMG (IEMG) and Duncan's multiple comparison tests revealed that the Aircast caused a significant reduction in IEMG of the ECRB and EDC when compared with control values and the standard band. The decrease in IEMG with the standard band was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic exercise-induced compartment pressure elevation measured with a miniaturized fluid pressure monitor. A laboratory and clinical study

Increased pressure within an osteofascial compartment may produce a compartment syndrome, one of the principal causes of circulatory compromise in acute traumatic and chronic exercise-induced elevated compartment pressure. Acute and chronic diagnostic quantitation of compartment pressures are a valuable adjunct to clinical diagnosis, particularly when used to evaluate the athlete with exercise-induced pain. This study evaluated a prototype hand-held, digital, fluid pressure monitor used for the measurement of compartment pressure in the exercising athlete. A laboratory water and mercury manometer study, in which 50 paired, single-blind measurements were taken, revealed that the digital monitor was accurate to +/- 0.8 mm Hg (SD) of actual pressure with no individual reading more than 1 mm Hg from the actual pressure when compared directly with a mercury and a water column. Laboratory study of bovine muscle placed within a pressure chamber revealed that the digital monitor, when assembled in the same manner as used for clinical measurement, was accurate to +/- 0.9 mm Hg. The needle manometer technique was also found to be accurate to +/- 3 mm Hg from actual pressure. Twenty-one paired measurements of the anterolateral and posterior compartments of the hindlimbs of eight anesthetized New Zealand White rabbits by both the needle manometer and digital monitor methods by two examiners demonstrated the digital monitor to be reproducible to +/- 1.0 mm Hg [Coefficient of variation (CV) less than 7%] and needle manometer method to +/- 3.4 mm Hg (CV less than 16%) with r = 0.94.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanics of the serve in tennis. A biomedical perspective

Epidemiological studies have indicated that the serve, arguably the most important facet of the game of tennis, is also the most likely stroke to cause injury, particularly to the elbow and back. A review of the kinematic and kinetic studies on the service action fails to clearly identify the reason(s) for these injuries. Data from these studies does, however, allow possible causes of injury to be postulated. Electromyographic data from the prime mover muscles involved in the serve have shown that muscle action was greater for beginners, whose muscles were active for longer periods than those of advanced players. Ground reaction forces associated with different serving techniques were small compared to those recorded from activities involving running or jumping. The potential to cause injury seems to be related to high internal forces (combination of muscle and joint reaction forces), particularly where these forces are associated with poor technique and high segment accelerations. These situations occur when the racket moves behind the body and the vertebral column is laterally flexed and hyperextended. The pronation of the forearm and the forces associated with the swing to the ball, the impact and the early follow through are also factors that have the potential to cause injury. The action of serving induces strains and pressures upon the body. A sensible approach to the number of serves, particularly when practising (overuse), appropriate physical preparation and a technique that does not introduce excessive forces to selected body parts (misuse) will greatly reduce the potential for injury from this activity.

Martial arts injuries. The results of a five year national survey

A 5 year national survey of martial arts was done using the National Electronic Injury Surveillance System (NEISS). Seventy-four percent of the injuries involved the extremities and 95% were mild to moderate in nature. Even though most of the injury types were contusions/abrasions (36%). lacerations (14%), and sprains/strains (28%), 15% were dislocations and fractures. Five percent of all injuries were severe, and there were 18 hospitalizations. There were no deaths. Weapon-related injuries were rare and never serious. Overall, the risk of serious injury in the sport was found to be low, especially when compared to other contact sports.

Manipulation in the treatment of tennis elbow

With the increasing popularity of tennis there has been an increasing interest in the etiology and treatrnent of lateral epicondylitis. The current pathophysiology is assumed to be related to repeated wrist extension and rotation leading to microtrauma at the common wrist extensor origin with an ultimate change in the histology of the area. Treatment involves exercise, the use of many modalities to treat the area locally, and more specifically when tennis is the etiology a whole variety of functional adaptations as well as a modification of equipment. Specifically, manipulation of the elbow has played a large role in the treatment of resistant tennis elbow and the large number of different named maneuvers has led to a certain amount of confusion. The second half of the paper attempts to review these manipulations including that described by Mills, Cyriax, Kaltenborn, Mennell, and Stoddard. These manipulations seem to fall into two basic varieties: those that seek full extension and those that will produce a varus thrust. The manipulations done with the elbow in extension and the forearm in pronation have the greatest chance of affecting the contractile elements whereas those performed with a varus thrust at the elbow seem to act primarily on the capsular structures causing gapping and restoring joint play. While manipulation may be effective it always must be used in conjunction with a total treatment regime including exercise, modalities, and modification of the activities involved in the etiology. J Orthop Sports Phys Ther 1986;7(5):264-272.

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).

Intracompartmental pressures on exertion in a patient with a popliteal artery entrapment syndrome

Intracompartmental pressure normally rises during exercise. Pressures in the anterior and deep posterior compartments of the leg were shown to decrease on exertion in a patient with a popliteal artery entrapment syndrome.

Chronic compartment syndrome: diagnosis, management, and outcomes

A consecutive operative series of 100 patients with chronic compartment syndrome involving 233 compartments is reported. Seven of every eight were athletes, and runners predominated. Exercise-induced symptoms of consistently recurring tightness, aching (in some, sharp pains) in anatomically defined compartments were pathognomonic. Mean months of symptoms prior to operation was 22; median age was 26 years. Bilaterality occurred in 82. The distribution of compartments was: anterior, 39%; lateral, 12%; and posterior, 48%. Incidental compartment pressures were elevated (mean = 23 mmHg). Fasciotomy using local anesthesia was performed on 70 outpatients. At a median of 4.5 months, over 90% were cured or significantly improved in symptoms and/or function. Median time to walking unassisted was 2 days, and to resumption of conditioned running 21 days. Fasciotomy can be a safe, effective, and economical treatment for chronic compartment syndrome.

Injuries of exercise

This article presents a brief overview of a few of the conditions that may affect the exercising individual. An accurate diagnosis and a positive attitude toward exercise on the part of the physician is stressed.

Monitoring dynamic anterior compartment pressures during exercise. A new technique using the STIC catheter

This report presents the early results of a new technique, using a solid-state transducer intracompartmental (STIC) catheter, developed to measure dynamic pressure changes in the anterior compartment of the leg in patients with exercise-induced anterior compartment syndrome. Nine male volunteers (15 limbs) with a history of exercise-induced anterior compartment pain were studied and compared to eleven asymptomatic male controls matched for age, weight and height. After catheter insertion, anterior compartment pressures were recorded with the subjects walking and running on a treadmill and performing several static maneuvers before and after the exercise period. The most statistically significant value between the two groups was the difference in mean pressure during running (P less than 0.001). Presently, all mean running pressures greater than 85 mm Hg are considered abnormal. This new technique offers the investigator the opportunity to measure dynamic intracompartmental pressures in symptomatic patients and provides an objective measurement for selection of patients for fasciotomy.

Conservative Treatment of Tennis Elbow

In briel: Classic tennis elbow is the result of a pathological entity the authors call fibroangiomatous hyperplasia. Their conservative treatment program has resulted in a high success rate, and includes the following steps: (1) relieving inflammation and pain with rest, ice, anti-inflammatory medications, and occasionally cortisone injections; (2) promoting the healing process with high-voltage galvanic stimulation; (3) exercises for strength, endurance, and flexibility in the arm and forearm; and (4) reducing the overload forces that caused the original injury by using a counterforce brace and modifying the player's technique and equipment. Surgery may be required as a last resort in patients with chronic symptoms.

A Study of Players With Pain

The results of this study suggest that the harmful effects of tennis are cumulative and that many variables may interact before elbow pain occurs.