The tennis elbow is classified according to cause and severity:

1. By cause:
   • Mechanical: Repeated movements or overloads that irritate the tendon attachments.
   • Traumatic: Acute injuries or microtraumas in the area of the tendon attachments.
2. By severity:
   • Mild: Pain occurs only under stress and is temporary.
   • Moderate: Pain is also present at rest and affects daily activities.
   • Severe: Persistent pain with limitation of mobility and strength.

The main causes are overload and repetitive movements that strain the tendon attachments:

• Mechanical stress:
  • Repeated movements such as lifting, gripping, or twisting, e.g., in sports activities (tennis, golf) or manual tasks (craftsmen, office work).
• Incorrect loading:
  • Unfavorable technique in sports activities, e.g., incorrect racket grip in tennis.
  • Insufficient ergonomic working conditions, e.g., in computer work.
• Traumatic causes:
  • Microtrauma or overuse of tendon attachments due to sudden load peaks.
• Degenerative factors:
  • Age-related changes in tendons that reduce their load-bearing capacity.

The symptoms vary depending on the severity of the inflammation and typically include:

• Pain: Localized pain on the outer elbow, which is intensified during exertion, such as lifting or gripping.
• Tenderness: Painful palpation of the lateral epicondyle.
• Loss of strength: Reduced grip strength and difficulties with everyday activities like holding objects.
• Movement restrictions: Discomfort when extending the wrist or fingers.
• Radiating pain: Pain may radiate into the forearm and occasionally into the shoulder.

The diagnosis is made through a combination of medical history, clinical examination, and, if necessary, imaging techniques:

- Medical history:

- Collection of symptoms, stress patterns, and possible triggers.

- Physical examination:

- Pain provocation tests such as the Cozen's test (resistance against wrist extension) or the Maudsley's test (resistance against finger extension).

- Palpation of the lateral epicondyle to determine tenderness.

- Imaging:

- Ultrasound: Visualization of inflammation or microtrauma of the tendons.

- MRI: Detailed analysis in case of suspected chronic damage or ruptures.

- X-ray: Exclusion of bony changes or osteoarthritis.

Conservative Therapy

Most cases can be successfully treated conservatively:

• Relief and Immobilization:
  • Avoidance of triggering activities and immobilization of the arm.
  • Use of elbow bandages or orthoses to relieve pressure.
• Physiotherapy:
  • Stretching and strengthening exercises to stabilize the muscles and improve mobility.
  • Manual therapy and trigger point treatment to relieve pain.
• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
  • Local injections of corticosteroids for severe discomfort.
• Shockwave Therapy: Promotes blood circulation and healing in the area of tendon attachments.
• Cryotherapy: Relief of acute pain through local application of ice packs.

Surgical Therapy

In severe or chronic cases that do not respond to conservative measures, surgery may be necessary:

• Tendon Reconstruction: Removal of damaged tissue and repair of tendon attachments.
• Decompression: Exposure and relief of the affected area.
• Minimally Invasive Procedures: Arthroscopic interventions with shorter recovery time.

To prevent tennis elbow and support recovery, the following measures are suitable:

1. Ergonomic working conditions: Adjusting workplace design, e.g., through ergonomic keyboards or wrist rests.
2. Correct technique: Training and optimizing movement sequences in sports or manual activities.
3. Regular training: Strengthening the forearm and hand muscles to improve resilience.
4. Load management: Avoiding excessive or unilateral loads through regular breaks.
5. Early treatment: At the first signs of pain, the load should be reduced and medical advice sought.