Causes of Tennis Elbow
The main reason is long-term overload [4] of the wrist extensor muscles and overlapping microtrauma of their enthesis (the places of attachment to the bone in the elbow area). The sum of microtraumas leads over time to the development of degenerative changes in the area of enthesis and chronic pain.
● Excessive tension in the muscles of the arm, leading to regular microtrauma to muscles and tendons and, as a result, to the development of inflammation;
● Age-related [5] dystrophic processes in muscle and tendon;
● Genetic weakness of the ligamentous apparatus;
● Other diseases of the musculoskeletal system;
Sometimes it happens that the disease appears for no apparent reason (sudden epicondylitis) or after a one-time intense overload of the forearm. The disease often becomes chronic, as it progresses rather easily and many people simply do not go to the hospital.
Interestingly, until recently, orthopedists believed that the aforementioned microtraumas caused inflammation of the attachment of the wrist extensor tendons. Consequently, non-steroidal anti-inflammatory drugs (NSAIDs [6]), steroid injections – the so-called blockade (a strong anti-inflammatory agent, however, causing irreversible damage to the tendons) and anti-inflammatory physical therapy were used.
The publication of an article in JBJS (Journal of Bone & Joint Surgery, USA) in 1999 by Dr. Robert P. Nirschel of Orthopedic & Sports Medicineclinic (Virginia, USA) changed (or at least had to change) a radical approach to treatment of ” tennis elbow.” From micro- and biochemical studies, it turned out that damage to the tendon attachment is not associated with a typical inflammatory process, but with a violation of the collagen structure and abnormal blood supply to the tendon at the attachment site. This means that it is not tendinitis (inflammation of the tendon), but tendinosis. Therefore, it is pointless to use anti-inflammatory treatment. Instead, other methods of treatment should be introduced that I use in my medical practice.