Management of Lateral Epicondylitis (Part 1)

This week, we start a new topic about lateral epicondylitis. 
Lateral epicondylitis (LE) was first described in 1873. It was known as chronic symptomatic degeneration of the forearm common extensor tendon attachment at the humeral ectocondyle. 
This condition is one of the most common overused syndromes. 
It is known that LE affects 1% to 3% of the population, mainly those middleaged people without gender difference. 
LE may lead to social and economic burden due to lost workdays and can even disable some sufferers from working for days if not weeks.
There is a lack of standards in LE treatment despite advances in the treatment technology.
Most cases require no treatment, as up to 80% cases may recover within one year.
In certain cases with refractory symptoms, these patients may require further treatments or surgery.
Even with modern medicine the exact cause of LE has not been well identified. However, it is commonly associated with repetitive microtrauma from excessive gripping or wrist extension, radial deviation, and/or forearm supination. 
The extensor carpi radialis brevis (ECRB) is the most frequently affected muscle in LE.
The pronator and other extensor carpal muscles are also commonly affected. 
LE was originally considered as an inflammation.  Now we know that overload or overuse can cause collagen fibril rupture and the activation of the innate immune system. However, in some studies, it has been shown that there is absence of inflammatory cells in cases of chronic LE. 
LE may be also linked with tendinosis, a symptomatic degenerative process that may be characterized by an increase in the number of fibroblasts, vascular hyperplasia, and unstructured collagen.
When there are repeated stretching, multiple microtears of the tendon, it may cause an irreversible denaturing of matrix proteins and tear of fibrous tissue. It may lead to scar tissues.
These scar tissues are vulnerable to repetitive forces, with subsequent further tears.
Evidence shows a link between the strain degree of tendons and the extent of injuries.
We will continue with the discussion on the management of LE in the next part of this column.