Hydrocortisone in tennis elbow

Abstract

T ENNIS elbow, known also as radiohumera1 bursitis, epicondylitis or epicondylaIgia, is a common and troublesome afhiction. It is characterized by pain originating around the outer side of the elbow joint at or beIow the lateral epicondyle. Radiation is frequent down the forearm. It is said to occur principahy in individuaIs who are carrying out frequent pronation-supination movements of the almost fully extended elbow. It may be reJated to athIetics or it may be occupational in nature. The exact pathoIogy of this entity is still debatable as is probabJe in many similar entities: The pathologic findings are muItipIe in nature since many changes in the soft tissues could be responsibIe for the symptoms attributed to this condition. The most commonly favored etiologic theory is that the symptoms result from an incompIete tear of the Iateral epicondylar origin of the forearm extensor tendons. It is beheved that the partial rupture may occur acutely or may be more gradua1 in onset. Another form is on the basis of a bursitis with or without amorphous calcium, and an actual bursal sac iying between the common extensor tendon and the lateral epicondyIe has been described in 16 per cent of cases. In most cases conservative treatment is successful in alleviating or completely relieving the painful symptoms. PhysicaI therapy is a useful adjuvant. LocaI procaine injections are occasionahy successful in some hands. However, a very acute and painful JIare-up of symptoms usuahy results from procaine infihrations; when such a reaction occurs, the rest& is usually poor. Many people favor the support of the wrist in the cock-up position in order to relieve the strain on the extensor tendon origin. Various specific manipulations under anesthesia have been described. BasicaIIy, these attempts are to convert what is believed to be a partiaI tear of the extensor tendon into a compIete and painJess tear. MiIJs forces the elbow into extension while the wrist and Jingers are fIexed and the forearm is fuIIy pronated. Cyriax extends the elbow with the forearm in supination and forcibly adducts it. Certain intractabre cases must be expIored. OccasionaIIy, a smaI1 bursal sac is found between the externa1 epicondyIe and the common extensor tendon origin. Excision of this results in complete relief. When a bursa1 sac is not found, the surgery invoIves a scratching of the origin of the tendon over the humera epicondyIe. Watson-Jones has described it as “a hen scratching in the barnyard.” Surgery usually resuJts in compIete and permanent cure. The success of hydrocortisone in the IocaI inhibition of mesenchymal proliferation prompted us to use it in tive cases of tennis eIbow. No other adjuvant therapy was given to these patients. In four cases relief was dramaticaIIy obtained. One patient failed to respond to two injections of hydrocortisone.