Shock wave therapy is a new, non-invasive, technique for the treatment of chronic tennis elbow, which is increasingly replacing surgery.
Pain at the lateral side of the elbow often originates from the extensor carpi radialis brevis. This introduction will use the term lateral epicondylalgia to describe this condition.
Prior Information of the patient's work or sport may give clues to an initial hypothesis.
Static working positions that require internal rotation of the shoulder are suggested to cause muscle imbalance and poor stability of the arm, this may then lead to overuse of extensor carpi radialis brevis and a subsequent lateral elbow pain. This situation is particularly common amongst keyboard workers.
If the patient were a keen tennis player, aged between 35 and 50 years, lateral epicondylalgia may also be indicated as a likely cause.
Radial tunnel syndrome is responsible for approximately 5% of the cases presenting with lateral elbow pain. An aid to the differential diagnosis of radial tunnel syndrome and lateral epicondylalgia is a knowledge of the location, and the character, of the pain. If the symptoms are located approximately four finger breadths distal to the lateral epicondyle radial tunnel syndrome should be suggested, whereas pain over the lateral epicondyle would suggest lateral epicondylalgia. The description of the pain quality may give further indication to the differential diagnosis as radial tunnel syndrome is suggested to cause a dull ache, whereas lateral epicondylalgia is suggested to cause a sharp or knifelike pai. In contrast some have described radial tunnel syndrome as causing a dull ache, and lateral epicondylalgia as causing a knifelike pain. Therefore inconsistency in the pain description may indicate low validity of this parameter. Pins and needles, or paraesthesia, in the area would indicate involvement of the neural tissue, such symptoms should be investigated further in the physical examination.