Lateral epicondylalgia (LE) also known as “tennis elbow”, is a prevalent musculoskeletal disorder classically characterised by pain over the lateral epicondyle of the humerus and marked deficits in the muscle and motor systems; typically associated with repetitive movement of the wrist and gripping tasks (Vicenzino, Cleland and Bisset, 2007). Although LE is commonly known as tennis elbow this term may be inappropriate as the condition is most ubiquitous (30-65% of all cases) in occupations attributing to repetitive mechanical stress (Dimberg, 1987; Murphy, Giuliani, and Freedman, 2006). Two studies (Norris, 2005; Schmidt,2006) have identified that LE occurs approximately in four to seven cases per 1000 patient visits in a general practice per year, estimating that one in three people might be suffering from LE at any given time. Allander (1974) and Varhaar (1994) produced epidemiological studies on LE and developed evidence that the condition is justifiably predominant in the general population by up to 3%. Chiang et al. (1993) and Ranney et al. (1995) found that up to 15% of workers employed in “at risk industries” experienced LE. At risk industries comprise of occupations that demand manual tasks, which include a combination of aggregates, such as force, poor posture, and repetition of the upper-limb (Vicenzino, 2003; Smidt et al, 2005). LE is widely recognised as a common “repetitive strain injury” that has a significant impact on individuals and the broad community (LaFreniere, 1979). Peak incidence primarily occurs in both genders alike between the ages of 35-54, typically involving the dominant arm (Allander, 1974; Smidt et al, 2002; Bot el al, 2005; Shiri et al, 2006). The condition is largely self-limiting with the duration of incidents ranging from six months to two years (Coombes, Bisset, and Vicenzino, 2009), with majority of those diagnosed (89%) affirming decreases in pain or full recovery at one year (Smidt et al, 2006). Vicenzino and Wright (1996) findings state otherwise, identifying that approximately 40% will experience persistent symptoms with the likelihood of decreased muscle and motor function.
The condition of LE is very intriguing, although it clinically presents with unsophisticated cardinal signs, the underlying aetiology has been much debated and still has no definite consensus (Vicenzino & Wright, 1996; Murphy, Giuliani, & Freedman, 2006). This lack of understanding makes it challenging to determine effective treatment and is prone to recurrent episodes (Labelle et al, 1992). In 1936, Dr. James Cyriax elucidated a theory that “lateral epicondylitis” was a progression of micro- and macroscopic tears in the common extensor tendon at the elbow due to long-term overuse; with continued mobilisation of the hand, these tears would be perpetual and would result in a chronic inflammatory response (Cyriax, 1936). Although this inflammatory theory has been widely acknowledged as a credible pathophysiological process, it has never been substantiated. By the year 1970, Dr. Robert Nirschl repudiated the model, investigating the histopathological assessments of over 600 cases of “lateral epicondylitis” (Kraushaar and Nirschl, 1999). Nirschl and Pettrone (1979) described the condition following the results of surgical interventions that it is in fact a chronic disorder due to the presence of degenerative changes in the connective tissue, characterised by the absence of inflammatory cells, the disorganisation of collagen, and increased number of immature fibroblasts at the origin of the Extensor Carpi Radialis Brevis (ECRB). This depiction has been reinforced by subsequent studies (Khan et al, 1999). These characteristics are demonstrated in degenerative processes, known as tendinosis (Esther, 2005). The term epicondylitis, as a diagnosisis is incorrect, and current evidence suggests the term be abandoned in favour of the appropriate terminology epicondylosis, or the generalised term epicondylalgia (Waugh,
