Lateral epicondylitis (tennis elbow) is one of the most common overuse syndromes of the upper extremity. It generally affects the dominant arm of individuals involved in racquet sports, but may also affect throwing athletes, golfers, laborers, and musicians. The pathologic changes to the lateral epicondyle occur from overuse of the wrist extensors, predominately the extensor carpi radialis brevis. The current therapies for this disorder include limitation of activity, lateral counterforce bracing (chopat strap), physical therapy, ice, and non-steroidal anti-inflammatories (NSAIDs). If these interventions are unsuccessful, cortisone injections or surgery may be offered. Individuals relying on oral NSAIDs for the management of their lateral epicondylitis may encounter significant side effects. The most serious side effects include peptic ulcer disease, upper gastrointestinal bleeding, aplastic anemia, renal failure, or death. These side effects are most prevalent in elderly individuals, the same individuals who are afflicted with overuse injuries. The use of a topical NSAID, with low systemic absorption (5-10%), and good local penetration, would hopefully provide symptomatic relief with less adverse effects.
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