Anyone for Tennis? Wimbledon Championships in full swing

And so to the gloriously British Grand Slam Premier Tennis event that is Wimbledon which is currently in full swing. Well – full swing insomuch as the British weather is currently allowing, but at least with the Centre Court’s retractable roof, installed in time for the 2009 Championships, we are guaranteed to get through at least some of the scheduled games every day. As I write in London not more than a few miles away from the courts, the rain is currently pouring down – a not so welcome tradition of the Championships, together with the more desirable traditions such as strawberries and cream, ‘Henman Hill,’ and the inevitable tireless British banter about why we haven’t managed to produce a Men’s Champion since the legendary Fred Perry way back in 1936 when he won for a third time.

A total of 128 players take part over the fortnight in the single tournaments, with 64 pairs in single-sex doubles and 48 couples in the mixed doubles. However, there are always a few high-profile players who don’t make it to the Championships because of injury. A quick look at the injury statistics reveals some of the big names you won’t be seeing this year including number 2 seed and current US and Australian Open Champion Kim Clijsters, Juan Carlos Ferrero, Sam Querry and Benjamin Becker. The good news is that current Ladies Champion, Serena Williams, is back to defend her crown after all of her well documented medical problems following a foot laceration on glass sustained in a restaurant.

Speaking of tennis, the BMJ recently published a review article by Orchard and Kountouris on the management of tennis elbow, perhaps better termed lateral elbow pain. Included in the online article is some useful video footage showing eccentric wrist extensor exercises, together with a discussion of the anatomy, pathophysiology and treatment options including some of the recently introduced therapies such as platelet-rich plasma. Interestingly, however, there is little mention of the efficacy of topical NSAIDS in the short term management as highlighted in the useful Clinical Knowledge Summary of the condition on the NHS Evidence website here. Given that these are widely available as over-the-counter preparations, I have always found them a cheap and useful ‘starter for ten’ in combination with ice, activity modification, paracetamol and eccentric exercises.

It seems that the effectiveness of surgery for the condition is still in some doubt according to the recently-updated Cochrane review on surgery for persistent lateral elbow pain. Their review included 5 trials of 191 participants with symptoms of at least 5 months’ duration and failed conservative treatment, and concluded that it was difficult to draw conclusions from the results of the trials due to issues of heterogeneity of interventions, small sample sizes and poor reporting of outcomes. Perhaps it is a blessing that much of the misery of the condition seems to resolve regardless of intervention between 6-12 months following the onset of symptoms.

Some useful CJSM articles on the topic of lateral elbow pain can be found below. Enjoy the tennis!

Hart, Lawrence MB. Short- and Long-Term Improvement in Lateral Epicondylitis. November 2007 – Volume 17 – Issue 6 – pp 513-514

Chung, B, Wiley, J, Preston MPE, Rose, M S. Long-Term Effectiveness of Extracorporeal Shockwave Therapy in the Treatment of Previously Untreated Lateral Epicondylitis. September 2005 – Volume 15 – Issue 5 – pp 305-312

Lebrun, C. Shock-Wave Treatment for Chronic Lateral Epicondylitis in Recreational Tennis Players. May 2005 – Volume 15 – Issue 3 – pp 198-199

Newcomer, Karen L. MD; Laskowski, Edward R. MD; Idank, David M. DO; McLean, Timothy J. RPT; Egan, Kathleen S. PhM. Corticosteroid Injection in Early Treatment of Lateral Epicondylitis. October 2001 – Volume 11 – Issue 4 – pp 214-222

Burnham, Robert,  Gregg, Randy, Healy, Pam,  Steadward, Robert. The Effectiveness of Topical Diclofenac for Lateral Epicondylitis. April 1998 – Volume 8 – Issue 2 – pp 78 – 81

Waskowitz, Robert S. M.D.; Hawkins, Richard J. M.D. 1996. Local Corticosteroid Injection Versus Cyriax-Type Physiotherapy for Tennis Elbow. October 1996 – Volume 6 – Issue 4 – ppg 276

About Chris Hughes
Associate Editor, Clinical Journal of Sport Medicine

One Response to Anyone for Tennis? Wimbledon Championships in full swing

  1. sportingjim says:

    Reblogged this on Clinical Journal of Sport Medicine Blog and commented:

    From the archives: with the U.S. Open in full swing, our Excecutive Editor Chris Hughes gives a thorough review on evidence-based treatments for lateral epicondylitis/’tennis elbow’

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