Orthopedics-Online

Diagnosis of tennis elbow

introduction

Under a Tennis elbow, also as Tennis elbow or in specialist circles Radialis humeric epicondylitis means a painful one Inflammation at the tendon attachment point of the Extensor muscles for the hands and fingers.

While the name might suggest, it is not a condition that exclusively affects tennis players. Rather, in general, is a Overload due to uniform work on the computer, for example, which lead to the smallest tears in the tendons of the muscles. These small injuries then solve one Inflammation of the periosteum and thus lead to the typical symptoms of a tennis elbow.

The patients report pain on outer elbowthat radiate into the forearm and often occur under strain on the muscles, e.g. when stretching the fingers.

diagnosis

Sharp pressure pain on the outer elbow is an indication of tennis elbow.

In order to be able to diagnose tennis elbow, the doctor first carries out one anamnese, in other words, a conversation with the patient, during which he is looking for the exact Type of complaint, sporting activities, previous illnesses as well as the professional situation asks. On the basis of the information obtained in this way, one then closes physical examination on.

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Physical examination

In the inspection the doctor first looks at the arm and especially the Elbow. He pays attention to abnormalities such as Swelling or Redness. Usually except for one eventual Relieving posture no external peculiarities to be found.

Then the elbow scanned. Patients often express one stabbing tenderness at the tendon attachment of the muscles to the bone of the outer elbow. The doctor tests mobility and movement-dependent pain by first passively changing the position of the patient's arm and wrist. After that, the patient actively performs the movements.

A There is usually no movement restriction with tennis elbow, however, patients often complain of one even with simple movements Weakness in the wrist. To get a tennis elbow from Golfer's elbow To be able to distinguish, the doctor pays close attention to the type and localization of the pain.
At the Tennis elbow the pain occurs on outer elbow on when the Elbow extended and hand passively flexed will or the Fingers against a resistance should be stretched.
On the other hand it comes with Golfer's elbow at Flexion of the wrist or at Lifting a heavy object to Inner elbow pain.

Test for a tennis elbow

If a tennis elbow is suspected, various clinical tests to be carried out for confirmation.

This includes, for example, the so-called Chair test: The patient is encouraged to use outstretched arm and forearm turned inward one Raise chair.

Another test is the Bowden testwhere the patient has a Blood pressure cuff with a certain pressure specified by the doctor press together should.

At the Thomson test should the patient die closed fist against the resistance extend the hand of the examiner, so bend backwards.

There is also that Mill test, the Movement stress test and the Cozen test.

Occur during these examinations Pain in the elbow up, the suspicion of a tennis elbow is confirmed. Often the doctor will also examine the Cervical spine, the shoulder and the Hand of the patientto rule out any other possible causes of the pain.

Neurological examination

In addition to motor skills, that is, mobility, blood flow and sensitivity of the arm are also tested, as both are Circulatory disorder, as well as a faulty innervation, in this case an overreaction of nerves, can lead to pain. The doctor will also examine whether a Nerve is pinched or squeezed causing pain.

The symptoms of tennis elbow are often so typical that the diagnosis can already be made by taking a medical history and physical examination. In exceptional cases, if, for example, other causes can trigger the pain, they close further technical investigations on. In addition to the tests that can be easily carried out in practice, there are then Laboratory tests and imaging procedures to use.

Blood count

The doctor will do a blood test to see if there are any signs of inflammation. To these so-called Inflammation parameters include the Sedimentation rate, which is increased in the presence of inflammation, the C-reactive protein, short CRP, a so-called acute phase protein, which is formed by the liver during inflammatory processes, and the blood count, which is increased in number during inflammatory processes Leukocytes notices.

These laboratory tests are relatively unspecific, i.e. the doctor cannot draw any conclusions about where the inflammation is taking place in the body, but in connection with the previous anamnesis and physical examination, a positive blood test for diagnosis a tennis elbow.

Ultrasonic

With regard to the imaging process, first of all is the Sonography, also echography or colloquially ultrasound, to call. If you have tennis elbow, there is one on the ultrasound image Swelling of the elbow joint to recognize. Furthermore, there is an increased Blood vessel formation and to changes in the affected tendon attachment points.

roentgen

To differentiate a tennis elbow from osteoarthritis, for example, an X-ray image of the elbow joint is made in two planes, i.e. from two different directions. In the case of osteoarthritis, changes in the joint would become visible on the X-ray. If the picture is inconspicuous, this usually speaks more for a tennis elbow.

MRI elbow for tennis elbow

Another method of imaging is the Magnetic resonance imaging, also called magnetic resonance imaging or MRI, in question. If there is a tennis elbow, a so-called signal increase can be seen. The MRI is based on magnetic wavesthat of different fabrics be emitted again as a signal of different strengths.

The different signal intensities can then be represented in slice images of the body as different gray levels. The physician understands a signal increase to mean that a tissue emits a stronger signal than the surrounding tissue and appears brighter in the MRT image than the surroundings.
The strength of the signal depends largely on the Hydrogen content of a tissue from. Inflamed tissue has a different hydrogen content than healthy tissue and can therefore be easily represented in the MRI image of the elbow.
Further information is also available from: MRI of the elbow

In summary, one can say that tennis elbow is primarily a clinical diagnosis that is made on the basis of anamnesis and physical examination. Laboratory diagnostics and imaging methods are only used in cases where several differential diagnoses are possible.