The Effect of Multimodal Approach of Electrotherapy Versus Shock Wave Therapy in Menopausal Women With Tennis Elbow.

Tennis Elbow (or Lateral Epicondylalgia) is one of the most common overload injuries that it is the most frequent cause of lateral elbow pain, occurring to people between 40-60 years of age. It is characterized by pain on the outside of the elbow, usually near the lateral epicondyle bone where the extensor carpi Brevis tendon attaches, aggravated by gripping or wringing activities During menopause period, declining estrogen levels can negatively impact tendon health. Estrogen plays a protective role in tendons, contributing to their strength and ability to withstand load.

Inclusion Criteria: 1\) forty five menopausel females suffer from chronic lateral epicondylitis from Department of out patient orthopedic clinic of 6 october hospital . (2) Their age ranged from 45 \_55 years old 3) Their BMI will be 18.5 to 24.9 kg/m2. 4) Point tenderness at the lateral epicondyle. 5) Positive Cozen test 6) Symptoms duration of minimum 3 months Exclusion Criteria: 1. Patients with cervical radiculopathy ,thoracic outlet syndrome , 2. dysfunction in shoulder or elbow with corticosteroid injection in previous three months. 3. Their BMI more than 25 kg/m2. 4. Unrelated to any traumatic conditions 5. Any previous fracture elbow, wrist or hand \-