Lateral+Epicondylitis+(Tennis+Elbow)

Lateral epicondylitis, popularly termed tennis elbow, is sprain or strain of the insertions of the extensor muscles of the forearm caused by overuse or trauma.

Symptoms
-Soreness and pain on the lateral aspect of the elbow near the lateral epicondyle -Pain may radiate distally along the extensor muscles of the forearm (the extensor muscles originate at the lateral epicondyle), into the hand, upper arm and shoulder -Pain is worse with grasping and pronation of forearm -Patient may exhibit weakness in affected arm doing simple tasks such as opening a door handle or shaking hands with someone. -Pain on lateral aspect of the elbow when the wrist is extended against resistance -Pain on lateral aspect of the elbow when extending the fingers against resistance -Pain when palpating distal to the lateral epicondyle.

Biomedical Treatment
-R.I.C.E. method (rest, ice, compression and elevation) in acute phase -Discontinuation of activities that cause the pain is recommended. -NSAIDs -Cortisone injection in chronic or severe cases -Ultrasound -Wrist splint or brace -PT; flexibility and strengthening exercises

TCM Disease Categorization
//Zhou Tong:// “elbow pain” //Shang Jin:// “damaged sinews” //Bi Zheng:// “painful obstruction syndrome” //Zhou Lao:// “elbow taxation”

TCM Etiology and Pathogenesis
Overuse, sprain/traumatic injury: causes damage to the sinews resulting in Qi stagnation and Blood stasis in the channels and collaterals; this, in turn, leads to lack of nourishment (Blood and Qi) to the sinews Wind-Cold-Damp invasion: local vacuity of Defensive Qi and Blood allows pathogenic factors to invade Chronic injury, aging: long-term stasis from chronic injury and decline of Qi and Blood/Liver and Kidney Qi due to aging results in lack of nourishment to the sinews
 * Repletion:**
 * Vacuity:**

Qi Stagnation & Blood Stasis
severe pain that is fixed in location and sharp or stabbing in quality; pain may be exacerbated by movement and is usually worse at night
 * Tongue:** normal color and coat (if chronic, may be dark/purplish)
 * Pulse:** wiry or choppy
 * Treatment Principle:** Move Qi and quicken the Blood, eliminate stasis and relieve pain

Cold-Damp Invasion
Symptoms: 1)Scatter Cold, expel Wind, eliminate Dampness, warm and open the channels and collaterals, relieve pain 2)Eliminate Dampness, expel Wind, scatter Cold, open the channels and collaterals, relieve pain
 * Cold predominant:** severe, fixed pain that is aggravated by cold and relieved by warmth
 * Damp predominant (a.k.a. Fixed Bi):** heavy, sore, fixed aching pain that is aggravated by dampness; numbness in the affected area may be present
 * Tongue:** possibly moist or greasy, white coating with Damp predominant
 * Pulse:** tight, slippery, slow are theoretically possible; wiry or tight are most common
 * Treatment Principle:**

Qi and Blood Deficiency
sore, aching pain exacerbated by exertion; possible muscle wasting or weakness; fatigue, poor appetite, loose stool, abdominal distention, facial pallor, dizziness, palpitations possible
 * Tongue:** pale and possibly scalloped
 * Pulse:** thin, weak, deep
 * Treatment Principles:** Boost Qi, nourish Blood, open the channels and collaterals, stop pain

Acupuncture Treatment:
Local points: LI-10, LI-11, LI-12, LI-13, Ashi Distal points: LI-4 Modification based on the pattern: Qi stagnation and Blood stasis: SP-10, 4 Gates Cold-Damp: Moxa Qi and Blood vacuity: BL-17, ST-36, CV-6 Herbal liniments and heat therapy

External Herbal Treatment:
Ding Xiang, Rou Gui powder in equal proportion. put moxa cone/tdp lamp on area over herbal powder. Also used in medial epicondylitis or golfer's elbow