Tennis elbow (also known as lateral epicondylitis) is a condition where the outer part of elbow becomes sore and tender.
Lateral eepicondylitis is an extremely common injury among sports people and manual workers where repetitive strain occurs to the elbow. There may have been recent changes in training or technique, note-taking or equipment used in sport or work. This strain leads to microscopic tears in the tendons of the extensor muscles at the outer elbow. These tears cause degeneration of the tendons and inflammation follows. Unfortunately over long periods of degeneration this inflammation becomes chronic.
Common Sources Include:
- Extensor muscles of the forearm: all wrist extensors form a common tendon. Damage to this tendon, often due to overuse, can lead to tennis elbow.
- Posterior interosseous nerve: a nerve that enters thru the supinator muscles can often be impinged along its course causing lateral elbow pain. Associated sensory symptoms, such as pins and needles, may indicate a nerve component.
- Synovitis of the radio- humeral joint – inflammation of the capsule around the shoulder joint
- Referred pain from the cervical, thoracic spine and the shoulder can often contribute to causing the elbow pain. Referred pain is affected by prolonged posture, such as lengthy periods seated at a desk or in a car. If pain is persistent, unpredictable or related to posture, referred pain should be considered.
Signs and Symptoms
Symptoms can include:
- Lateral elbow pain extending into the forearm and extensor muscles: pain usually builds up gradually.
- Associated symptoms can include stiffness and tightness particularly in the morning
- Inflammation may keep the patient awake at night.
- Made worse by activities that use the muscles – lifting, gripping, turning knobs/taps
- Reduced strength in gripping and activities that use the affected muscles
- Pins and needles in the hand
Tennis elbow can usually be diagnosed by a detailed history and physical examination.
It is important in assessment to differentiate local elbow pain from that involving the neck or nerve structures.
An activity history will also be taken, noting any recent change in the level of activity. In racquet sport players, any change in racquet size, grip size or string tension and whether or not any comment has been made regarding his or her technique.
There are two stages involved in the management of tennis elbow
1. Reducing symptoms in the acute phase
In this phase different treatments are used to reduce pain and maintain function. These may include:
- Use of ice to reduce inflammation
- Taping to correct biomechanics of the elbow or off load extensor muscles
- Hands on therapy to optimize function of the elbow joint and extensor muscles and tendons
- Dry needling may be useful to reduce tone in the forearm extensor muscles
- Stretches both in the treatment room and at home form an important part of this phase
- Activity modification or modification of training regimen.
- Treatment of the neck may be indicated where this is a component of the problem
2. Maintenance phase
This phase will include exercises to strengthen the extensor tendons and for posture correction. Return to sport and activity follows.