Tennis Elbow

TENNIS ELBOWTennis elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called “tennis elbow”, it should be noted that it is not restricted to tennis players.

If one hyper extends an elbow in any sport, this may be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The medical term is lateral epicondylitis.

Etiology

With tennis elbow, the extensor carpi radialis brevis tendon has been identified as the primary site of pathological change. The tendon of the extensor carpi brevis muscle at approximately 2cm below the outer edge of the elbow joint or lateral epicondyle of the humerus bone. There have also been pathological changes found at the extensor digitorum communis, longus and ulnaris tendons. The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing stresses during all movements of the forearm. It is acknowledged that tennis elbow is caused by repetitive microtrauma/overuse. Inflammatory changes have been noted in the acute stages of the condition but have been found to be absent if symptoms become chronic (3 months +).

Specific inflammation is rarely present in the tendon but there is an increase in pain receptors in the area making the region extremely tender.

Risk factors for this condition vary from taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).

Symptoms

  • Pain on the outer part of elbow (lateral epicondyle).
  • Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
  • Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone.
  • Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee or throwing a baseball.
  • Pain on the outside of the elbow when trying to straighten the fingers against resistance
  • Pain usually subsides overnight.
  • If no treatment given, can become chronic and more difficult to eradicate.

Differential diagnosis for tennis elbow includes anconeus compartment syndrome, bursitis, cervical radiculopathy, radio-humeral joint dysfunction, hypothyroidism, lateral epicondyle avulsion, musculocutaneus nerve entrapment, non-union of radial neck fracture, osteoarthritis, posterior interosseous syndrome, posterolateral rotatory instability, radial nerve tension, radial tunnel syndrome, rheumatoid arthritis, strained lateral collateral ligaments, and snapping plicae syndrome.

Physioline’s Treatment

  • Rest
  • Cold compression therapy
  • Bracing- to reduce the range of movement in the elbow and thus reduce the use and pain. Ergonomic advice is recommended to help with the successful relief of lateral elbow pain.
  • Manual therapy
  • Progressive strengthening for this condition involves using weights or elastic theraband to increase pain free grip strength and forearm strength
  • Soft Tissue Release or simply Massage can help reduce the muscular tightness and reduce the tension on the tendons.
  • Strapping of the forearm can help realign the muscle fibers and redistribute the load.
  • Nerve mobilisations can be given if there is a positive nerve tension test in evaluation

How long with tennis elbow take to get better?

Tennis elbow may heal quickly within two weeks but it could last for up to two years. When the symptoms have settled down it is essential full rehabilitation and strengthening of the elbow takes place.

Prevention:

  • Correct technique – play the backhand with the whole body not just the wrist!
  • Use a forearm brace or heat retainer if you have a weak wrist or elbow.
  • Do not play with wet, heavy balls.
  • Use a light racket if you do not play very often.
  • Make sure your strings are not too tight.
  • Be aware of too much strain on the elbow for example when doing DIY or using a keyboard. Apply ice after use to reduce any inflammation