Tennis elbow

Tennis elbow (lateral epicondylitis) is characterised by pain and tenderness over the lateral epicondyle of the humerus. In the UK, the annual incidence of lateral elbow pain in general practice is around 4/1000 to 7/1000 people.(Hamilton 1986) It is most common in people aged between 40 and 50 years (Allander 1974); for example, the incidence is as much as 10% in women aged 42 to 46 years.(Chard 1989; Verhaar 1994)

Tennis elbow is considered an overload injury, and it typically occurs after minor trauma of the extensor muscles of the forearm; tennis is a direct cause in only 5% of people with the condition.(Murtagh 1988). It is primarily a type of tendonitis though the muscles and bones of the epicondyle joint may also be involved. Pain can also occur on the inner side of the elbow, which is known as golfer's elbow. Although generally self-limiting, symptoms of tennis elbow can persist for 1.5 to 2 years or even longer in a minority of people.(Hudak 1996)

The aims of conventional medical interventions are to relieve pain, control inflammation and accelerate repair in order to improve function. Treatments include corticosteroid injections, topical and oral NSAIDs, other analgesics, exercises, ultrasound, orthoses and surgery.

References

Allander E. Prevalence, incidence and remission rates of some common rheumatic diseases and syndromes. Scand J Rheumatol 1974; 3: 145-53.

Chard MD, Hazleman BL. Tennis elbow - a reappraisal. Br J Rheumatol 1989; 28: 186-90.

Hamilton P. The prevalence of humeral epicondylitis: a survey in general practice. J R Coll Gen Pract 1986; 36: 464-5.

Hudak P et al. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Arch Phys Rehabil 1996; 77: 568-93.

Murtagh J. Tennis elbow. Aust Fam Physician 1988; 17: 90-1, 94-5.

Verhaar J. Tennis elbow: anatomical, epidemiological and therapeutic aspects. Int Orthop 1994; 18: 263-7.

How acupuncture can help

One systematic review concluded that acupuncture was beneficial for pain, at least in the short term, although the amount of evidence was limited (Green 2002). Two years later, a second review with more data available, found strong evidence of short-term pain relief (Trinh 2004). Most randomised controlled trials not included in these systematic reviews have compared different types of acupuncture, so can tell us little about the overall effectiveness of acupuncture for the treatment of tennis elbow.(Su 2010; Gu 2007; Xia 2004; Tsui 2002) One trial, however, compared electroacupuncture plus moxibustion with lidocaine plus prednisone treatment, and found the acupuncture treatment to be more effective.(Jiang 2005) The fact sheet on Sports Injuries has more information on other tendinopathies.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body's homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the 'analytical' brain, which is responsible for anxiety (Wu 1999).

Acupuncture may help relieve symptoms of tennis elbow, such as pain and inflammation by:

• stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);

• delivering analgesia via alpha-adrenoceptor mechanisms (Koo 2008);

• increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);

• modulating the limbic-paralimbic-neocortical network (Hui 2009);

• reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);

• improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.