Tennis Elbow

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Articles
Tennis elbow Golfer's elbow 1 7

References
Article Sources and Contributors Image Sources, Licenses and Contributors 9 10

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Tennis elbow

Tennis elbow
Tennis
Classification and external resources

Left elbow-joint, showing posterior and radial collateral ligaments. (Lateral epicondyle visible at center.) ICD-10 ICD-9 DiseasesDB eMedicine MeSH M77.1 726.32 12950 [1] [2] [3] [4] pmr/64 [5] sports/59 [6]

orthoped/510 D013716 [7]

Lateral epicondylitis or lateral epicondylalgia, also known as tennis elbow, shooter's elbow and archer's elbow, is a condition where the outer part of the elbow becomes sore and tender. It is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anyone.[8]
Example of repetitive movement which may

Tennis elbow is an overuse injury occurring in the lateral side of the cause tennis elbow elbow region, but more specifically, occurs at common extensor tendon that originates from the lateral epicondyle. While the common name tennis elbow suggests that people who play tennis may develop this condition, other activities of daily living may also cause it.[9] Data was collected from 113 patients who had tennis elbow and the main factor between them all was overexertion. Sportspersons as well as those who used the same repetitive motion for many years, especially in their profession, suffered from tennis elbow. It was also common in individuals who performed motions they were unaccustomed to. The data also mentioned that the majority of patients suffered tennis elbow in their right arms.[10]

Tennis elbow

Other descriptions for tennis elbow are lateral epicondylosis, lateral epicondylalgia, or simply lateral elbow pain.

Activity which may cause pain (Lifting with the palm down)

Lateral epicondylitis is a painful condition at the lateral epicondyle of the humerus. The acute pain that a person might feel occurs as one fully extends the arm. Since the pathogenesis of this condition is still unknown, an appropriate name is still in the works. Despite the term being tennis elbow, tennis players make up a small number of individuals who suffer from this ailment, often found in manual workers, such as builders and waiters. Bowden states that it should be called lateral elbow syndrome.[11] Runge is usually credited for the first description in 1873 of the condition.[12] The term tennis elbow was first used in 1883 by Major in his paper "Lawn-tennis elbow".[13] [14]

Signs and symptoms

Pain on the outer part of elbow (lateral epicondyle). Point tenderness over the lateral epicondyle a prominent part of the bone on the outside of the elbow. Gripping and movements of the wrist hurt, especially wrist extension and lifting movements. Activities that use the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful. Morning stiffness. The symptoms associated with tennis elbow are, but are not limited to: radiating pain from the outside of your elbow to your forearm and wrist, pain during extension of wrist, weakness of the forearm, a painful grip while shaking hands or torquing a doorknob, and not being able to hold relatively heavy items in the hand. The pain is similar to the pain of the condition known as Golfer's elbow but the latter occurs at the medial side of the elbow.[9]

Causes
During early experiments, it was thought that tennis elbow was primarily caused by overexertion. Studies have shown that trauma such as direct blows to the epicondyle, a sudden forceful pull, or forceful extension have caused more than half of these injuries.[10] One explanation of how tennis elbow may come about is proposed by Cyriax. The theory states that there are microscopic and macroscopic tears between the common extensor tendon and the periosteum of the lateral humeral epicondyle. An operation conducted in this study showed that 28 out of 39 patients showed tearing at the tendon cuff. Kaplan stated that the radial nerve was significantly involved in tennis elbow. He noted the constriction of the radial nerve by adhesions to the capsule of the radiohumeral joint and the short extensor muscle of the wrist. Evidence found that many differed in how they contracted tennis elbow. Disorders such as calcification of the rotator cuff, bicipital tendinitis, or carpal tunnel syndrome may increase chances of tennis elbow.[10]

Tennis elbow

Pathophysiology
The pathophysiology of lateral epicondylitis is degenerative. Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis (ECRB) muscle are identified in surgical pathology specimens.[15] It is unclear if the pathology is affected by prior injection of corticosteroid. Among tennis players, tennis elbow is believed to be caused by the repetitive nature of hitting thousands and thousands of tennis balls which lead to tiny tears in the forearm tendon attachment at the elbow.[16] The extensor digiti minimi also has a small origin site medial to the elbow which can be affected by this condition. The muscle involves the extension of the little finger and some extension of the wrist allowing for adaption to "snap" or flick the wrist usually associated with a racquet swing. Most often, the extensor muscles become painful due to tendon breakdown from over-extension. Improper form or movement allows for power in a swing to rotate through and around the wrist creating a moment on that joint instead of the elbow joint or rotator cuff. This moment causes pressure to build impact forces to act on the tendon causing irritation and inflammation. The following speculative rationale is offered by proponents of an overuse theory of etiology: The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shear stress during all movements of the forearm. While it is commonly stated that lateral epicondylitis is caused by repetitive microtrauma/overuse, this is a speculative etiological theory with limited scientific support that is likely overstated.[15] Other speculative risk factors for lateral epicondylitis include taking up tennis later in life, unaccustomed strenuous activity, decreased mental chronometry and speed and repetitive eccentric contraction of muscle (controlled lengthening of a muscle group).

Prevention
Another factor of tennis elbow injury is experience and ability. The proportion of players who reported a history of tennis elbow had an increased number of playing years. As for ability, poor technique increases the chance for injury much like any sport. Therefore an individual must learn proper technique for all aspects of their sport. The competitive level of the athlete also affects the incidence of tennis elbow. Class A and B players had a significantly higher rate of tennis elbow occurrence compared to class C and novice players. However, an opposite, but not statistically significant, trend is observed for the recurrence of previous cases, with an increasingly higher rate as ability level decreases.[9] Other ways to prevent tennis elbow: Decrease the amount of playing time if already injured or feel pain in outside part of elbow Stay in overall good physical shape Strengthen the muscles of the forearm (Pronator quadratus, Pronator teres and Supinator muscle), the upper arm (biceps, triceps, Deltoid muscle), the shoulder and upper back (trapezius) Increased muscular strength will increase the stability of joints such as the elbow Like other sports, use equipment appropriate towards your ability, body size and muscular strength.[9]

Diagnosis
To diagnose tennis elbow, the physician performs a battery of tests in which pressure is placed on the affected area while the patient is asked to move the elbow, wrist, and fingers. X-rays are used to confirm and distinguish possibilities of existing causes of pain that are not related to Tennis Elbow, such as fracture or arthritis. Medical ultrasonography and magnetic resonance imaging (MRI) are other valuable tools for diagnosis but are frequently avoided due to the high cost.[9] MRI screening can confirm excess fluid and swelling in the affected region in the elbow, such as the connecting point between the forearm bone and the extensor carpi radialis brevis.

Tennis elbow The diagnosis is made by clinical signs and symptoms, which are both discrete and characteristic. With the elbow fully extended, there are points of tenderness over the affected point on the elbow, which is the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (extensor carpi radialis brevis origin). There will also be pain with passive wrist flexion and resistive wrist extension (Cozen's test).[17] Depending upon the severity and quantity of multiple tendon injuries that are built up, the extensor carpi radialis brevis may not be fully healed by conservative treatment. Nirschl has defined four stages of lateral epicondylitis, showing the introduction of permanent damage beginning at Stage 2. 1. 2. 3. 4. Inflammatory changes that are reversible Nonreversible pathologic changes to origin of the extensor carpi radialis brevis muscle Rupture of ECRB muscle origin Secondary changes such as fibrosis or calcification.[18]

Treatment
Evidence for the treatment of lateral epicondylitis is poor.[19] There are clinical trials addressing many of these proposed treatments, but the quality of the trials is poor.[20] In some cases, severity of tennis elbow symptoms mend without any treatment within six to twenty-four months. However, if tennis elbow is left untreated, it can lead to chronic pain that degrades quality of daily living.[9]

Physical
There are several recommendations regarding prevention, treatment, and avoidance of recurrence that are largely speculative[15] including stretches and progressive strengthening exercises to prevent re-irritation of the tendon[21] [22] and other exercise measures. Evidence suggests that joint mobilization with movement directed at the elbow resulted in reduction in pain and improved function.[23] Positive results have been found with manipulative therapy directed at the cervical spine, although data regarding long-term effects were limited.[24] Low level laser therapy administered at specific doses and wavelengths directly to the lateral elbow tendon insertions offers short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen.[25]

Medication
Topical non-steroidal anti-inflammatory drugs (NSAIDs) to relieve lateral elbow pain in the short term, however there were no improvements found in functional outcomes. Injected NSAIDs were suggested to be better than oral NSAIDs. There was insufficient evidence to recommend or discourage the use of oral NSAIDs.[26] Corticosteroid injection are effective in the short term[27] however are of little benefit after a year compared to a wait and see approach.[28] Complications from repeated steroid injections include skin problems such as hypopigmentation and fat atrophy leading to indentation of the skin around the injection site.[27] Botulinum toxin type A to paralyze the common extensor origin chronic tennis elbow that has not improved with conservative measures.[29]

Tennis elbow

Surgery
In recalcitrant cases, surgery may be an option.[30]

Prognosis
Response to initial therapy is common, but so are relapse (18% to 50%) and/or prolonged, moderate discomfort (40%).

Epidemiology
In tennis players, about 39.7% have reported current or previous problems with their elbow. Less than one quarter (24%) of these athletes under the age of 50 reported that the tennis elbow symptoms were "severe" and "disabling." While 42% over 50 identified severe and disabling symptoms. More women (36%) than men (24%) considered their symptoms to be severe and disabling. Tennis elbow is more prevalent in individuals over 40, where there is about a 4-fold increase among men and 2-fold increase among women. Tennis elbow equally affects both sexes and although men have a marginally higher overall prevalence rate as compared women, this is not consistent within each age group, nor is it a statistically significant difference.[31] Playing time is one factor in tennis elbow occurrences. However, an increased incidence with increased playing time is statistically significant for only respondents under the age of 40. Individuals over the age of 40 who played over 2 hours, had a 2-fold increase in chance of injury. Those under 40 had a 3.5 times increase compared to those who played less than 2 hours per day.[9]

References
[1] [2] [3] [4] [5] [6] [7] [8] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ M77. 1 http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=726. 32 http:/ / www. diseasesdatabase. com/ ddb12950. htm http:/ / www. emedicine. com/ orthoped/ topic510. htm http:/ / www. emedicine. com/ pmr/ topic64. htm# http:/ / www. emedicine. com/ sports/ topic59. htm# http:/ / www. nlm. nih. gov/ cgi/ mesh/ 2011/ MB_cgi?field=uid& term=D013716 Tennis elbow: even [[cricketers (http:/ / timesofindia. indiatimes. com/ cms. dll/ html/ uncomp/ articleshow?msid=839418)] and housewives can get it], a Times of India article dated September 4, 2004 [9] "Tennis Elbow - MayoClinic.com." Mayo Clinic Medical Information and Tools for Healthy Living - MayoClinic.com. 15 Oct. 2008. Web. 10 Oct. 2010. (http:/ / www. mayoclinic. com/ health/ tennis-elbow/ DS00469) [10] KURPPA, K., WARIS, P. and ROKKANEN, P. Tennis elbow: Lateral elbow pain syndrome. Scand j. work environ. & health 5 (1979): suppl. 3, 15-18. A review of the etiology, occurrence and pathogenesis of "tennis elbow" is presented. [11] BOWDEN, B. W. Tennis elbow. J. am. Osteopath. Assoc. 78 (1978) 97-98, 101-102 [12] Runge F. Zur Genese und Behandlung des Schreibekrampfes. Berliner Klin Wochenschr. 1873;10:245248. [13] Major HP. "Lawn-tennis elbow". BMJ. 1883;2:557. [14] Kaminsky SB, Baker CL; Baker (December 2003). "Lateral epicondylitis of the elbow". Techniques in Hand & Upper Limb Surgery 7 (4): 17989. doi:10.1097/00130911-200312000-00009. PMID16518219. [15] Boyer MI, Hastings H (1999). "Lateral tennis elbow: "Is there any science out there?"". Journal of Shoulder and Elbow Surgery 8 (5): 48191. doi:10.1016/S1058-2746(99)90081-2. PMID10543604. [16] What is tennis elbow? (http:/ / news. bbc. co. uk/ sportacademy/ hi/ sa/ treatment_room/ features/ newsid_3818000/ 3818931. stm) from the BBC Sport Academy website [17] Tennis elbow (http:/ / www. nlm. nih. gov/ medlineplus/ ency/ article/ 000449. htm) from the MedlinePlus Medical Encyclopedia [18] Owens, Brett D; Moriatis Wolf, Jennifer; Murphy, Kevin P (2009-11-03). "Lateral Epicondylitis: Workup" (http:/ / emedicine. medscape. com/ article/ 1231903-diagnosis). eMedicine Orthopedic Surgery. . Retrieved 2010-04-19. [19] Bisset L, Paungmali A, Vicenzino B, Beller E (July 2005). "A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia". British Journal of Sports Medicine 39 (7): 41122; discussion 41122. doi:10.1136/bjsm.2004.016170. PMC1725258. PMID15976161. [20] Cowan J, Lozano-Caldern S, Ring D (August 2007). "Quality of prospective controlled randomized trials. Analysis of trials of treatment for lateral epicondylitis as an example". The Journal of Bone and Joint Surgery 89 (8): 16939. doi:10.2106/JBJS.F.00858. PMID17671006.

Tennis elbow
[21] Stasinopoulos D, Stasinopoulou K, Johnson MI (December 2005). "An exercise programme for the management of lateral elbow tendinopathy". British Journal of Sports Medicine 39 (12): 9447. doi:10.1136/bjsm.2005.019836. PMC1725102. PMID16306504. [22] Tennis elbow (http:/ / airbed. ch/ tennisarm/ ) [23] Vicenzino B, Cleland JA, Bisset L. (2007). "Joint Manipulation in the Management of Lateral Epicondylalgia: A Clinical Commentary". Journal of Manual & Manipulative Therapy 15 (1): 5056. doi:10.1179/106698107791090132. PMC2565595. PMID19066643. [24] Herd CR, Meserve BB. (2008). "A Systematic Review of the Effectiveness of Manipulative Therapy in Treating Lateral Epicondylalgia". Journal of Manual & Manipulative Therapy 16 (4): 22537. doi:10.1179/106698108790818288. PMC2716156. PMID19771195. [25] Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI (2008). "A systematic review with procedural assessments and meta-analysis of Low Level Laser Therapy in lateral elbow tendinopathy (tennis elbow)". BMC Musculoskeletal Disorders 29: 75. doi:10.1186/1471-2474-9-75. PMC2442599. PMID18510742. [26] Green S, Buchbinder R, Barnsley L, Hall S, White M, Smidt N, Assendelft W (2002). Green, Sally. ed. "Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults" (http:/ / www. ncbi. nlm. nih. gov/ pubmed/ 12076503). Cochrane Database of Systematic Reviews 2 (2): CD003686. doi:10.1002/14651858.CD003686. PMID12076503. . [27] Coombes, BK; Bisset, L, Vicenzino, B (2010 Nov 20). "Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials". Lancet 376 (9754): 175167. doi:10.1016/S0140-6736(10)61160-9. PMID20970844. [28] Haines T, Stringer B (April 2007). "Corticosteroid injections or physiotherapy were not more effective than wait and see for tennis elbow at 1 year". Evidence-based Medicine 12 (2): 39. doi:10.1136/ebm.12.2.39. PMID17400631. [29] Kalichman, L; Bannuru, RR, Severin, M, Harvey, W (2011 Jun). "Injection of botulinum toxin for treatment of chronic lateral epicondylitis: systematic review and meta-analysis". Seminars in arthritis and rheumatism 40 (6): 5328. doi:10.1016/j.semarthrit.2010.07.002. PMID20822798. [30] Lo, MY; Safran, MR (2007 Oct). "Surgical treatment of lateral epicondylitis: a systematic review". Clinical orthopaedics and related research 463: 98106. doi:10.1097/BLO.0b013e3181483dc4. PMID17632419. [31] Gruchow, William, and Douglas Pelletier. "An epidemiologic study of tennis elbow: Incidence, recurrence, and effectiveness of prevention strategies." American Journal of Sports Medicine. 7.4 (1979): 234-238. Print.

Further reading
Wilson JJ, Best TM (September 2005). "Common overuse tendon problems: A review and recommendations for treatment" (http://www.aafp.org/afp/20050901/811.html). American Family Physician 72 (5): 8118. PMID16156339.

Golfer's elbow

Golfer's elbow
Golfer's elbow
Classification and external resources

Left elbow-joint, showing anterior and ulnar collateral ligaments. (Medial epicondyle labeled at center top.) ICD-10 ICD-9 DiseasesDB eMedicine M77.0 726.31 5356 [1] [2]

[3] [4] pmr/74 [5]

sports/74

Golfer's elbow, or medial epicondylitis, is an inflammatory condition of the medial epicondyle of the elbow. It is in some ways similar to tennis elbow. The anterior forearm contains several muscles that are involved with flexing the fingers and thumb, and flexing and pronating the wrist. The tendons of these muscle come together in a common tendinous sheath, which is inserted into the medial epicondyle of the humerus at the elbow joint. In response to minor injury, or sometimes for no obvious reason at all, this point of insertion becomes inflamed.

Causes
The condition is called Golfer's Elbow because in making a golf swing this tendon is stressed, especially if a non-overlapping (baseball style) grip is used; many people, however, who develop the condition have never handled a golf club. It is also sometimes called Pitcher's Elbow[6] due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Other names are Climber's Elbow and Little League Elbow: All of the flexors of the fingers insert at the medial epichondyle, making this the most common elbow injury for rock climbers, whose sport is very grip intensive.

Golfer's elbow

Treatment
Non-specific palliative treatments include: Non-steroidal anti-inflammatory drugs (NSAIDs): ibuprofen, naproxen or aspirin Heat or ice A counter-force brace or "elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage. Before anesthetics and steroids are used, conservative treatment with an occupational therapist is attempted. Before therapy can commence, treatment such as the common rest, ice, compression and elevation (R.I.C.E.) will typically be used. This will help to decrease the pain and inflammation. The rest will help with the discomfort seeing as how Golfer's Elbow is an overuse injury. The patient can use a tennis elbow splint for compression. A pad can be placed anteromedially on the proximal forearm.[7] The splint is made in 3045 degrees of elbow flexion. A daytime elbow pad also may be useful, by limiting additional trauma to the nerve. Therapy will include a variety of exercises for muscle/tendon reconditioning, starting with stretching and gradual strengthening of the flexor-pronator muscles. Strengthening will slowly begin with isometrics and progresses to eccentric exercises helping to extend the range of motion back to where it once was. After the strengthening exercises, it is common for the patient to ice the area.[7] Simple analgesic medication has a place, as does more specific treatment with oral anti-inflammatory medications (NSAIDs). These will help control pain and any inflammation.[7] A more invasive treatment is the injection into and around the inflamed and tender area of a long-acting glucocorticoid (steroid) agent. After causing an initial exacerbation of symptoms lasting 24 to 48 hours, this may produce a resolution of the condition in some five to seven days. The ulnar nerve runs in the groove between the medial humeral epicondyle and the olecranon process of the ulna. It is most important that this nerve should not be damaged accidentally in the process of injecting a Golfer's Elbow. If all else fails, epicondylar debridement (a surgery) may be effective. The ulnar nerve may also be decompressed surgically.[7] The overall prognosis is good. Few patients will need to progress to steroid injection and even fewer, less than 10%, will need surgical intervention.[7]

References
[1] [2] [3] [4] [5] [6] http:/ / apps. who. int/ classifications/ icd10/ browse/ 2010/ en#/ M77. 0 http:/ / www. icd9data. com/ getICD9Code. ashx?icd9=726. 31 http:/ / www. diseasesdatabase. com/ ddb5356. htm http:/ / www. emedicine. com/ sports/ topic74. htm http:/ / www. emedicine. com/ pmr/ topic74. htm# "Pitcher's Elbow - Stanford Sports Medicine - Stanford Medical Outpatient Center" (http:/ / outpatient. stanfordhospital. org/ clinics/ orthopaedics/ sportsmedicine/ procedures/ shoulder/ pitcher. html). Stanford University Medical Center. . Retrieved 2009-09-09. [7] Gibbs, Sharon J. and Kenneth S. Dauber. "Medial Epicondylitis." eMedicine. 12 Aug. 2009. WebMD. 01 Dec. 2009 <http://emedicine.medscape.com/article/327860-overview>.

Article Sources and Contributors

Article Sources and Contributors

Tennis elbow Source: http://en.wikipedia.org/w/index.php?oldid=458717145 Contributors: 5 albert square, Af042, Ajmusiq83, Alex.tan, Algont, AllyD, Alro, Amayzes, Andrestjean, Annemoss, Anthony Bradbury, Apapadop, Ar-wiki, Arcadian, Arcann, Aree, Autumnalmonk, Avinashpr, Bathrobe, Before My Ken, Bogey97, Brookie, Careck, Cburnett, Cclin, Chris Capoccia, CirrusHead, CliffC, CmdrRickHunter, Cmdrjameson, Colonies Chris, Cometstyles, Coupdeforce, Crookedsquare, Csigabi, Cyde, DVdm, Dave3141592, Davidruben, Dilleaux, Dinosaurdarrell, DoctorDW, Dontmentionit, Dr311, Dreish, DropDeadGorgias, Eagle4000, Edric etty ed, Eiriksolheim, Elz dad, Epbr123, Excirial, Ezhiki, Forge999, Funandtrvl, Gammel nisse, Gilliam, Greg Kuperberg, Gregojmg, GregorB, Guanaco, Gurch, Gwernol, Gwinva, Haham hanuka, HamburgerRadio, HannaLi, Hariva, Headbomb, Hemanshu, Hooperbloob, ICanDoItNineTimes, IRP, Ian Pitchford, Iiamjon, J.delanoy, JWWalker, Je at uwo, Jfdwolff, Jhsounds, Jimwilcox79, Jmh649, Jonnytaylor, Julia Rossi, Kafziel, Karl.brown, Kesal, Koavf, L Kensington, Lamro, Landon1980, Lastexpofan, LitCigar, Ljaic, M.C., MER-C, Max.just.nu, Michael Devore, Michellecrisp, Mjquinn id, MorganaFiolett, Movses, MrOllie, MrSomeone, Mrfebruary, Mwanner, Navigator1972, Nehrams2020, Nick, Nicke L, Nurg, Onlinegamer1, Orangemarlin, Orannis, Outside Media, Paincheng, PaperTruths, Philbradley, Phtyex, Piano non troppo, Pimpdaddydiamond, Professor.linforth, Puhlaa, QuinnHK, Qwyrxian, RexNL, Rgoodwin13, Rhcastilhos, Rich Farmbrough, Richard2321, Rjwilmsi, Ronz, Rossfraser2020, Royce, SchuminWeb, Scriberius, Sltruong, Sonjaaa, StaticGull, Stephenb, Stevage, SuperHamster, Susanlea, Sysy, Tarek, Taueres, The Thing That Should Not Be, Ticklemygrits, Ultrahawkeye, Verdatum, Vernetto, Wafulz, Widefox, Wikipelli, Wikiuser100, Wimt, Wine Guy, Wright93, 312 , 55, anonymous edits Golfer's elbow Source: http://en.wikipedia.org/w/index.php?oldid=450339739 Contributors: AnjaManix, Anomalocaris, Anthony Bradbury, Arcadian, Besha, Bodydoctor70, Coloradogal99, Davidruben, Dddstone, Eagle4000, Eleassar, GregorB, Iiamjon, Mandarax, Max.just.nu, Quintote, Rhcastilhos, Saganaki-, Salgene, Thingg, Tohd8BohaithuGh1, W guice, Wikiuser100, Xic667, 32 ,55 anonymous edits

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Image Sources, Licenses and Contributors

File:Epicondyluslateralishumeri.png Source: http://en.wikipedia.org/w/index.php?title=File:Epicondyluslateralishumeri.png License: Public Domain Contributors: Engusz, Flominator File:Tenniselbow.JPG Source: http://en.wikipedia.org/w/index.php?title=File:Tenniselbow.JPG License: Creative Commons Attribution 3.0 Contributors: Strong File:Tennis elbow lift.jpg Source: http://en.wikipedia.org/w/index.php?title=File:Tennis_elbow_lift.jpg License: Creative Commons Attribution 3.0 Contributors: Sltruong File:Gray329-Medial epicondyle of the humerus.png Source: http://en.wikipedia.org/w/index.php?title=File:Gray329-Medial_epicondyle_of_the_humerus.png License: Public Domain Contributors: Original uploader was Engusz at hu.wikipedia

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