الفهرس 
Anatomy of elbow jointOnly 14 pages are availabe for public view
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Abstract
Lateral epicondylitis is one of the widely seen lesions of the arm
characterized by pain localized over lateral epicondyl which is the insertion site of wrist extensors ,and extensor muscles of the forearm.
Its prevalence in general population ranges between 1-3% which peaks between 40-50 years of age.
It is seen more frequently in females, and more often affect the dominant hand.
Although its etiology is not known fully, reports indicate potential roles of aging, chemical, vascular, hormonal, hereditary factors.
Lateral epicondylitis is frequently seen in individuals performing activities which repetitvely strain extensor muscles of the wrist.
It is characterized by pain, and decreas in grip strength which might
manifest with resisted wrist extention, and extention of the middle finger
accompanied with restriction of daily living activity.
Lateral epicondylitis is typically diagnosed using clinical criteria. Imaging techniques including musculoskeletal ultrasonography
Tendon changes observed with gray scale MSUS of the common extensor tendon of people with LE include tendon thickening, focal areas of tendon hypoechogenicity.
Extracorporeal shock wave therapy (ESWT) is a noninvasive procedure in which acoustic waves are focused on targeted sites within the body to facilitate pain relief and healing . In general, ESWT is considered safe, noninvasive, easy to apply, and well tolerated by most patients, and so has been widely used for many musculoskeletal conditions over the last 25–30 years .
Local corticosteroid injection represents a common approach to the
treatment of several musculoskeletal disorder. It is a simple, inexpensive
procedure, aiming at reducing pain and other symptoms associated with the inflammatory process. Corticosteroid suppresses the immune system by supressing the pro-inflammatory protiens.
The aim of this study was to evaluate the effectiveness extracorporial
shock wave therapy (ESWT) and local corticosteroid injection in
management of tennis elbow clinically and ultrasonographically.
This study was carried out on 30 patient (with lateral epicondylitis)
from the inpatients and the outpatients clinic of Rheumatology, Rehabilitation and Physical Medicine department, Benha university hospitals.
In this study, most of the studied cases (90%) had right dominant hand and also laterality of painful hand
In our study, the highly significant effectiveness of CS injection on pain and functional disability parameters as VAS, PRTEE, and Quick dash test show a high significant difference among CS injection group before , after 2W, 4 W.
In our study, the highly significant effectiveness of ESWT on pain and functional disability parameters as VAS, PRTEE, and Quick dash test show a high significant difference among ESWT group before , after 2W, 4 W.
In this study, there was a significant improvement in ESWT patients two and four weeks after treatment than local CS injection group.
There was a significant difference in between CS injection and ESWT before and after 2 weeks regarding to VAS test.
As regard to PRTEE and Quick dash test, there was a significant difference in between CS injection and ESWT two and four weeks after .
There was no statistical significant difference in between the studied groups regarding to tendon thickening before but after 2W and 4 W there was a significant difference .
There was no statistical significant difference in between the studied groups according to US changes (focal areas of hypo-echogenicity) through follow up periods (two weeks and 4 weeks) .
86.7% of the studied cases had Positive US changes (focal areas of hypo-echogenicity) after 2weeks while only 30% had positive US changes after 4 weeks but only 13.3 % had positive US changes after 8 weeks and 10% had positive US changes after 12 weeks .
As regard to tendon thickening , it was positive in 76.7% of the cases before while after 2weeks it was positive in 63.3% of the studied cases and it was positive in only 33.3% of the studied cases after 4 weeks. After 8 weeks it was positive in 13.3 % and after 12 weeks it was positive in 3.3% from all the studied cases.