Chronic Tennis Elbow Might Be an Instability Issue

Chronic tennis elbow might involve instability in elbow joint. I remember being taught to always inject the radio-humeral joint and I can see why if much of the time pathology exists there. Might explain recurrence rates.

Knee Surg Sports Traumatol Arthrosc. 2017 in press.
doi: 10.1007/s00167-017-4530-x.
Intra-articular findings in symptomatic minor instability of the lateral elbow (SMILE).
Arrigoni P et al.
https://www.ncbi.nlm.nih.gov/pubmed/28341879

• 35 cases between 20 and 60 years
• recalcitrant lateral epicondylitis
• without overt elbow instability

scenario is as follows:

• Certain movements strain elbow joints

• annular ligament elongation and instability radial head
• Impingement radial head – I presume part of what they call radial head ballottement – seen in near 1/2 cases
• Cartilage damage to Capitellum (CLAC lesion)
• Capsular tears
• Extensor Carpi Radialis Brevis dynamic stabilizing overstrain with your tennis elbow

With Elbow arthroscopy they found

• ~ 1/2 recalcitrant lateral epicondylitis  have  signs of lateral ligamentous instability
• > 85% demonstrate at least one intra-articular abnormality synovitis or capitellar chondropathy

Comment – makes a case for prolotherapy to elbow joint to stabilize condition though they did not mention. They mentioned a lesion called snapping plica syndrome – a band in joint that snaps – I have that condition which can be annoying but seems to settle with use in gym.

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