Tennis Elbow (Lateral Epicondyalgia)

Tennis Elbow (Lateral Epicondyalgia)

  If you have tennis elbow you can experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when your forearm muscles are stretched. There is probably tenderness directly over the lateral epicondyle, the bony bump on the outside of the elbow, and tender points (trigger points) in the forearm muscles. In some cases, you may also experience neck stiffness and tenderness, and possibly also signs of nerve irritation like numbness and tingling. Most elbow movements are pain-free despite the surrounding area being painful.

WHO IS AFFECTED?

  You don’t have to be a tennis player to suffer from tennis elbow. It is caused by the repetitive movements and the gripping actions common in tennis hence the term ‘tennis’ elbow. However, it may also occur in other activities requiring repetitive gripping actions. Tennis elbow can therefore stem from daily activities such as using scissors, cutting meat, carrying grocery bags, gardening, manual work that involves repetitive turning or lifting of the wrist, such as plumbing, or bricklaying, and typing.

ACUTE VS CHRONIC

  Acute tennis elbow, also known as lateral epicondylitis, is an injury to structures involved in extending (straightening) the wrist and fingers at the site where the forearm muscles attach to the bone via the extensor tendon. It occurs when more force is applied to that area than the normal healthy tissue can handle. For example:

• Unaccustomed hand use such as starting the tennis season,or increasing the frequency or amount of time playing tennis too quickly. Sometimes just a weekend of home DIY may trigger it
• Excessive gripping or wringing activities, possibly a new racket or different grip size
• Poor forearm muscle strength or tight muscles
• Poor technique (this may be a poor tennis shot).

  Chronic (ie. longer term) tennis elbow is associated with degenerative changes in the tendon. While a sudden acute flare up of tennis elbow may have some inflammation or swelling, chronic tennis elbow generally doesn’t involve inflammation and is instead associated with changes in the nerves and blood supply to the tendon.   Unfortunately, rest as a treatment is rarely helpful. If left untreated, tennis elbow can last anywhere from 6 months to 2 years and can have a serious effect on your sport, daily activities and work. Physiotherapy is effective both in acute and chronic tennis elbow, and there are several things you can do to help in recovery and prevention.  

TREATMENT

  Tennis elbow should be diagnosed by a physiotherapist or doctor. A history is taken, and tests performed. Referred pain from the neck and reduced nerve mobility can mimic tennis elbow. The physical therapist must check your neck and clear it from any involvement in your elbow pain. An ultrasound scan or MRI are the best tests to identify tendon damage,but are often not necessary.   Physical or manual therapy treatments than can help include:

• Massage therapy to relieve pain and stretch tight muscles and structures
• Manual therapy can mobilise joints in the elbow and around the neck to ensure normal function
• Taping and braces are beneficial in reducing pain in the elbow and supporting the muscles when you return to sport n Ice and ultrasound therapy may be used to reduce inflammation.
• Dry needling can also be effective for pain relief, releasing trigger points in the muscle and promoting tissue healing
• Exercise therapy should be prescribed to strengthen and balance the muscles of the forearm. While stretches help to lengthen tight muscles.

  Other treatment options may include injections, which should only be considered if the exercises have not helped. Surgery can be carried out under local injection (subcutaneous tenotomy) with a 95% success rate and no reduction in grip strength.   You need to try and prevent tennis elbow from occurring or recurring, which unfortunately it has a tendency to do, which means finding out what caused the injury and addressing these issues with the help of your therapist.