Outline:   
This disease is also called "tennis elbow". It is often caused by a long-term overstrain that gives repeated stimulation to the starting point of forearm carpal extensor, resulting in a pathological changes of partial laceration and aseptic inflammation of the extensor or local synovial hyperplasia and synovitis. But, it is also believed that the compression of the nerves and blood vessels running through the general extensor tendon is the cause. It mostly occurs in people of special occupations such as bricklayer, tiler, carpenter, engraver and tennis player.
 
Major points for diagnosis  
1. There is a history of repeated overstrain of forearm.

2. The disease progresses gradually. There is pain in lateral aspect of the elbow, which sometimes radiates to the shoulder and wrist. The sick arm is sore and weak. The severity of symptoms varies.

3. There is a definite tenderness at lateral epicondyle of humerus. The tension test of carpal extensors is positive.

4. Generally there is no positive sign in X-ray film, but in a few patients with a long course, there may be a shadow of osteosclerosis and periosteal proliferation in the external humeral epicondyle.

Tendon-smoothing manipulation:
First, massage and grasping-kneading manipulation are performed on the painful points and region around the elbow for 3 to 5 minutes so that the local areas become slightly hot and blood flows smoothly. Then the operator, holding the medial side of the sick elbow with one hand and the sick wrist with the other hand, first extends and flexes the elbow joint several times, then makes it quickly flex several times, and rotates simultaneously. If the elbow is in a supination position when it is straightened out, pronation will be performed; and if the elbow is in a pronation position when it is straightened out, supination will be performed. Each movement is done for 3 to 5 times so as to resolve adhesion and relieve pain.

Herbaltherapy
Internal treatment based on syndrome differentiation

(1) Syndrome of stagnation of qi and blood
Main symptoms and signs:
Severe pain in the elbow radiating to the forearm, or swelling, failure of the hand in carrying weight, or ecchymoses on the tongue, stringy or thready-choppy pulse.
    
Therapeutic methods:
Promoting blood flow to remove the stasis, activating qi flow to stop pain.

Recipe and herbs:
Modified Huoxue Decoction. Specifically, Chaihu (Radix Bupleuri) 6g, Honghua(Flos Carthmi) 6 g, Danggui (Radix Angelicae Sinen-sis)  10 g,  Chishaoyao  ( Radix Paeniae Rubrae )  10 g, Taoren ( Semen Persicae)  10 g,  Zhike (Fructus Citri Aurantii )  lo g, Zhechong (Eupolyphaga seu Steleopha-ga) 10 g, Jixueteng ( Caulis Spatholobi)  15 g,  Xuejie (Resina Draconis) 3 g and Gancao (Radix Glycyrrhi-zae) 3 g.
     
(2) Syndrome of collateral disharmony
Main symptoms and signs:
Aching and vague pain in the lateral side of the elbow, weakness of the sick arm, pale tongue and thready pulse.
    
Therapeutic methods:
Relaxing tendons and activating collaterals.

Recipe and herbs:
Modified Huoxue Shujin Decoction. Specifically, Qianghuo (Rhizoma seu Radix No-topterygii) 6g, Jingjie (llerba Schizonepetae) 6g, Honghua ( Flos Carthmi) 6 g, Zhike (Fructus Citri Au-rantii) 6 g, Duhuo (Radix Angelicae Pubescentis) 9 g, Fangfeng (Radix Ledebouriellae Divaricatae) 9 g, Niuxi(Radix Achyranthis Bidentatae) 9 g, Wujiapi ( Cortex Acanthopanacis) 9 g, Duzhong ( Cortex Eucommiaeul_ moidis) 9 g, Danggui (Radix Angelicae Sinensis) 12 g, Xuduan ( Radix Dipsaci )  12 g,  Qingpi  ( Pericarpium Citri Reticulatae Viride) 5 g and Gancao (Radix Gly-cyrrhizae) 3 g.

External therapy:
Dingtong Paste may be externally applied; or Haitongpi Decoction is used to fumigate and wash the diseased parts.

Functional exercise:   
In order to prevent rigidity of the elbow joint and adhesion of soft tissues around it, the patient is encouraged to do active exercises every day by clenching fist, flexing elbow, pronation, forceful stretching forearm and throwing out fist. But the complete rest should be prescribed for the patients with serious pain in the elbow at the acute inflammation stage. Or the forearm is suspended with cloth band in front of chest.
 
Hydro-acupuncture therapy:
Twomil-limeters of 1% procaine plus 12. 5 mg prednisolone is used for point infection at the painful points, once a week for consecutive 3 or 4 times. However, it should be given up if it does not work. Or 2 ml of Danggui Injection is used for painful point injection, once every other day.