Tennis elbow

Japanese: テニス肘 - テニスひじ（英語表記）Tennis elbow

What kind of disability is it?

Tennis elbow is an injury caused by repeated tennis strokes. There are two types of tennis elbow: backhand tennis elbow, which causes pain on the outside of the elbow during a backhand stroke, and forehand tennis elbow, which causes pain on the inside of the elbow during a forehand stroke.

In both cases, it is thought that the impact of the ball hitting the racket is repeatedly applied to the muscles that move the wrist at their attachment points to the elbow, causing micro-tears and damage.

In the former case, the humerus is attached to the muscle that dorsiflexes the wrist (bends it toward the upper arm). Lateral epicondyle ( Immediate response ) (the protrusion on the outside of the elbow) and the latter on the wrist. Palmar flexion ( Food ) The humerus, which has the muscle that bends it (toward the palm) Inside ( Notified ) Because they occur in the epicondyle, they are also called lateral epicondylitis of the humerus and medial epicondylitis of the humerus, respectively.

The incidence of backhand tennis elbow (lateral epicondylitis) is known to be low in younger people and more common in those in their late 30s to 50s.

How symptoms manifest

In backhand tennis elbow, pain occurs on the outside of the elbow with every backhand stroke, and in forehand tennis elbow, pain occurs on the inside of the elbow with every forehand stroke. In addition, pain in the same area occurs in everyday life outside of tennis with every wrist-using action, such as wringing out a towel or turning a doorknob.

Testing and diagnosis

Tenderness is felt on the outside or inside of the elbow. In backhand tennis elbow, movement pain occurs on the outside of the elbow when the wrist is dorsiflexed. Pain is induced when the wrist is dorsiflexed with resistance or when the patient is asked to lift a chair with the elbow extended (Thomsen test, chair test).

Treatment methods

Depending on the severity of the symptoms, the patient may be completely rested from tennis in order to rest the local area. On the other hand, a combination of forearm stretching, strength training, physical therapy such as heat, low frequency, and laser light, tennis elbow supports, and oral and topical anti-inflammatory analgesics may be used. In some cases, local injections of steroid hormones may be administered, but this should only be done during the acute phase.

Surgery is also considered effective when conservative treatment is ineffective. Surgical methods include extensor tendon origin release, extensor fasciotomy, partial resection of the annular ligament or joint capsule, and intra-articular synovectomy, but no clear difference has been observed in the results.

Prevention measures

Methods for preventing tennis elbow, including preventing recurrence, include choosing a racket with looser strings, improving your form, stretching your forearm, using a support, and icing your elbow after playing tennis.

Prince Kato

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな障害か

　テニス肘とはテニスのストロークを繰り返し行ったことで肘が痛くなる障害で、バックハンドストロークで肘の外側を痛めるバックハンドテニス肘と、フォアハンドストロークで肘の内側を痛めるフォアハンドテニス肘があります。

　どちらもボールがラケットに当たる時の衝撃が、手首を動かす筋肉の肘への付着部に繰り返し加わることによって、微小断裂や損傷を来し発生するものと考えられます。

　前者では手首を背屈する（甲側に曲げる）筋肉がついている上腕骨外側上顆(がいそくじょうか)（肘の外側のでっぱり）に、後者では手首を掌屈(しょうくつ)（手のひら側に曲げる）する筋肉がついている上腕骨内側(ないそく)上顆に発生するため、それぞれ上腕骨外側上顆炎、上腕骨内側上顆炎ともいわれます。

　バックハンドテニス肘（上腕骨外側上顆炎）の発生頻度については、若年層で少なく、30代後半から50代に多いことがわかっています。

症状の現れ方

　バックハンドテニス肘ではバックハンドストロークのたびに肘の外側に、フォアハンドテニス肘ではフォアハンドストロークのたびに肘の内側に疼痛が現れます。また、テニス以外の日常生活でも、タオルを絞る、ドアのノブをまわすなどの手首を使う動作のたびに同部位に疼痛が現れます。

検査と診断

　肘の外側または内側に圧痛が認められます。バックハンドテニス肘では手首を背屈させる動きで肘の外側に運動痛を生じます。抵抗を加えた状態で手首を背屈させたり、肘を伸ばした状態で椅子を持ち上げさせると痛みが誘発されます（トムセンテスト、チェアーテスト）。

治療の方法

　症状の程度によっては、局所を安静にするためテニスを完全に休ませます。その一方で、前腕ストレッチング、筋力トレーニング、温熱、低周波、レーザー光線などの理学療法、テニス肘用サポーター、消炎鎮痛薬の内服や外用などを組み合わせて行います。場合によってはステロイドホルモンの局所注射をすることもありますが、急性期にとどめるべきでしょう。

　また、手術については保存療法が無効な際に有効とされています。手術方法としては、伸筋腱起始部解離術、伸筋筋膜切開術、輪状靭帯や関節包の部分切除術、関節内の滑膜切除術などがありますが、成績にはっきりした差は認められていません。