ORIGINAL ARTICLES   

The Journal of Sports Medicine and Physical Fitness 1999 September;39(3):244-8

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Tennis elbow, natural course and relationship with physical activities: an inquiry among physicians

Mens J. M. A. ¹, Stoeckart R. ², Snijders C. J. ³, Verhaar J. A. N. ⁴, Stam H. J. ¹

¹ Departments of Rehabilitation Medicine, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands; ² Departments of Anatomy, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands; ³ Departments of Biomedical Physics and Technology, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands; ⁴ Departments of Orthopedic surgery, Faculty of Medicine and Health Sciences, Erasmus University Rotterdam, The Netherlands

Background. The ­main pur­pos­es of the ­study ­were to ­answer the fol­low­ing two ques­tions: is a restric­tive ther­a­peu­tic man­age­ment in ­case of ten­nis ­elbow (TE) bet­ter or ­worse ­than a reg­u­lar ther­a­peu­tic ­approach and do rack­et ­sports and oth­er phys­i­cal activ­ities influ­ence the ­risk to get TE and to ­what ­extent.
Methods. Design: Cross-sec­tion­al ­study by ­means of a post­al ques­tion­naire. The impres­sion was ver­i­fied ­that phy­si­cians are ­reserved ­about med­i­cal inter­ven­tions ­when treat­ing them­selves for ten­nis ­elbow. The fre­quen­cy of ther­a­peu­tic meas­ures and ­their ­results ­were com­pared ­with ­data report­ed in lit­er­a­ture. Physical activ­ities of phy­si­cians who had TE ­were com­pared ­with ­those of phy­si­cians who nev­er had TE. Setting: Physicians who attend­ed post­grad­u­ate cours­es on diag­no­sis and treat­ment in ortho­pe­dic med­i­cine ­from 1984 to 1992. Participant: 72 phy­si­cians who had TE and 266 ­with no his­to­ry of TE. Measure: The ­study is ­based on ­self-assess­ment of ther­a­peu­tic approach­es and ­their ­results, report­ed phys­i­cal activ­ities at the ­onset of TE and at the ­moment of the ­inquiry. By a ­team of ­experts the ­grade of grasp­ing and/or dor­si­flex­ion of the phys­i­cal activ­ities was clas­si­fied.
Results. Compared ­with ­patients in gen­er­al prac­tice, phy­si­cians treat­ing them­selves for TE ­were ­more restric­tive to use NSAID’s, oint­ments or ­local ster­oid injec­tions or to con­sult a spe­cial­ist. No-one was treat­ed ­with sur­gery and no-one inter­rupt­ed her/his ­work ­because of TE. In all but two of the 72 cas­es the TE ­resolved with­in two ­years. The ­odds ­ratio for TE for play­ing rack­et ­sports ver­sus not play­ing rack­et ­sports was 2.8 (95% con­fi­dence inter­val 1.64-4.82). The ­odds ­ratio for activ­ities ­with low-­grade grasp­ing and/or dor­si­flex­ion ver­sus “no ­sports or hob­bies” was 0.11 (0.02-0.50).
Conclusions. Absence ­from ­work and ther­a­peu­tic meas­ures for TE are (in phy­si­cians) not nec­es­sary for a ­good ­result on the ­long ­term. Playing rack­et ­sports increas­es the ­risk to get TE by a fac­tor of 2.8. Performing week­ly activ­ities ­with low ­grade grasp­ing and/or dor­si­flex­ion of the ­wrist may ­have a pro­tec­tive ­effect ­against devel­op­ing ten­nis ­elbow.