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Clin Sports Med 1995 Jan;14(1):47-57

The biomechanics of tennis elbow. An integrated approach.

Roetert EP, Brody H, Dillman CJ, Groppel JL, Schultheis JM

United States Tennis Association, Key Biscayne, Florida, USA.

Tennis elbow afflicts 40% to 50% of the average, recreational tennis players; most of these players more than 30 years of age. Tennis elbow is thought to be the result of microtrauma, the overuse and inflammation at the origin of the ECRB as a result of repeated large impact forces created when the ball hits the racket in the backhand stroke. Several authors have found that EMG activity in the ECRB, the muscle and tendon complex afflicted in tennis elbow, is high during the acceleration and early follow-through phases of the groundstrokes and during the cocking phase of the serve. Unfortunately, none of the authors gave evidence to support the claim that muscle activity in the ECRB at ball contact is high. In the one-handed backhand, the torques at impact (17-24 nm) will be absorbed by the tendons of the elbow. Giangarra and his colleagues observed that the two-handed backhand "allows the forces at ball impact to be transmitted through the elbow rather than absorbed by the tissues at the elbow." Other authors have reported that players using a two-handed backhand will rarely develop lateral epicondylitis, because the helping arm appears to absorb more energy and changes the mechanics of the swing. As seen by Morris and colleagues, Giangarra and associates, and Leach and colleagues, players who utilize the two-handed backhand have a very low incidence of tennis elbow. These three studies conclude that the two-handed backhand stroke is probably the most effective backhand stroke to prevent lateral tennis elbow. Studies show that wrist extensors are highly involved in all strokes (serve, forehand, and both one- and two-handed backhand strokes). This relatively high involvement (40%-70% MVC) throughout play may result in overload of this muscular group. Thus, tennis elbow may be caused simply by continued use of this muscular system in all strokes, and not just because of the high forces absorbed at impact. Another theory concerning impact states that if the extensor group is already at near maximum contraction, vibrations and twisting movements are transferred directly through the muscle (muscle stiffness at this point would be great) to the tendinous insertion, causing repeated microtrauma. If the muscle is the stiffest element in the system, the force will be transferred to the tendon. It is evident that a need exists for specific study of muscular response during impact. More microanalysis of the impact phase needs to be conducted specifically for the one-handed backhand groundstroke.

J Am Osteopath Assoc 1993 Jul;93(7):778

Tennis elbow: a biomechanical and therapeutic approach.

Schnatz P, Steiner C

Department of Osteopathic Sciences, University of Medicine and Dentistry of New Jersey--School of Osteopathic Medicine, Stratford.

Lateral epicondylitis, one of the most common lesions of the arm, affects some 50% of tennis players. This condition poses a problem in clinical management because treatment is dependent not only on proper medical therapy but also on correction of the improper on-court biomechanics. The most common flaw is a late contact on the backhand groundstroke, forcing the player to extend the wrist with the extensor muscles. This action predisposes to trauma of the tendon fibers at the lateral epicondyle. Understanding the biomechanics will better prepare the physician to advise the patient and to communicate with a tennis teaching professional to facilitate long-term relief.

Int Orthop 1994 Oct;18(5):263-267

Tennis elbow. Anatomical, epidemiological and therapeutic aspects.

Verhaar JA

Department of Orthopaedics, University Hospital Maastricht, The Netherlands.

Five studies of tennis elbow are presented. Epidemiological studies showed an incidence of tennis elbow between 1 and 2%. The prevalence of tennis elbow in women between 40 and 50 years of age was 10%. Half of the patients with tennis elbow seek medical attention. Local corticosteroid injections were superior to the physiotherapy regime of Cyriax. Release of the common forearm extensor origin resulted in 70% excellent or good results one year after operation and 89% at five years. Anatomical investigations and nerve conduction studies of the Radial Tunnel Syndrome supported the hypothesis that the Lateral Cubital Force Transmission System is involved in the pathogenesis of tennis elbow.

Scand J Work Environ Health 1995 Dec;21(6):478-486

Humeral epicondylitis among gas- and waterworks employees.

Ritz BR

Department of Epidemiology, UCLA 90025-1772, USA.

OBJECTIVES: In this cross-sectional study 290 male employees of the public gas- and waterworks of Hamburg, Germany, were examined for symptoms of epicondylitis. Forty-one workers were diagnosed with symptoms of lateral or medial epicondylitis. The effect of employment in different job categories on the prevalence of epicondylitis was explored. METHODS: The diagnosis of epicondylitis was based on the study's own criteria and compared with criteria used in former studies. Jobs were categorized into high, moderate, and no exposure groups according to tasks regarded as strenuous for the elbow. The data were analyzed with the help of multivariate logistic regression. RESULTS: With the study's diagnostic criteria, the prevalence odds ratio (OR) for 10 years of high exposure to elbow straining work was 1.7 [95% confidence interval (95% CI) 1.04-2.68] for current ly held jobs and 2.16 (95% CI 1.08-4.32) for formerly held jobs. For workers regarded as moderately exposed in current jobs the odds ratio for 10 years was 1.4 (95% CI 1.00-1.93). Very similar results were obtained for current exposure when stricter diagnostic criteria were employed. CONCLUSIONS: The results suggest a cumulative exposure effect with length of employment. Workers with high exposure in former jobs compared with employees with high exposure in their current job exhibited more residual or slight epicondylitis symptoms upon examination.


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