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Physical and psychosocial risk factors for lateral epicondylitis: a population based case-referent study
  1. J P Haahr,
  2. J H Andersen
  1. Department of Occupational Medicine, Herning Hospital, DK-7400 Herning, Denmark
  1. Correspondence to:
 Dr J P Haahr, Department of Occupational Medicine, Herning Hospital, DK-7400 Herning, Denmark;


Aims: To assess the importance of physical and psychosocial risk factors for lateral epicondylitis (tennis elbow).

Methods: Case-referent study of 267 new cases of tennis elbow and 388 referents from the background population enrolled from general practices in Ringkjoebing County, Denmark.

Results: Manual job tasks were associated with tennis elbow (odds ratio (OR) 3.1, 95% confidence interval (CI) 1.9 to 5.1). The self reported physical risk factors “posture” and “forceful work” were related to tennis elbow. Among women, work involving performing repeated movements of the arms was related to tennis elbow (OR 3.7, CI 1.7 to 8.3). Among men, work with precision demanding movements was related to tennis elbow (OR 5.2, CI 1.5 to 17.9). Among both males and females, the results for work with hand held vibrating tools were inconsistent, partly because of few exposed subjects. A physical strain index was established based on posture, repetition, and force. The adjusted ORs for tennis elbow at low, medium, and high strain were 1.4 (CI 0.8 to 2.7), 2.0 (CI 1.1 to 3.7), and 4.4 (CI 2.3 to 8.7). Low social support at work, adjusted for physical strain, was a risk factor among women (OR 2.4, CI 1.3 to 4.6).

Conclusion: Results indicate that being a new case of tennis elbow is associated with non-neutral postures of hands and arms, use of heavy hand held tools, and high physical strain measured as a combination of forceful work, non-neutral posture of hands and arms, and repetition. Furthermore, tennis elbow among women was associated with low social support at work. The results for precision demanding movements and for vibration were less consistent.

  • tennis elbow
  • musculoskeletal disorder
  • social support
  • multifactorial
  • lateral epicondylitis
  • BMI, body mass index
  • CI, confidence interval
  • GP, general practitioner
  • MRW, monotonous repetitive work
  • OR, odds ratio

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  • Funding: the Research Council of the National Working Environment Authority, the Danish Insurance Association, and the Medical Research Unit of Ringkjoebing County