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Tennis Elbow

Summary:


Tennis elbow is an overuse injury involving the muscles and tendons of the forearm that attach to the bony prominences called lateral epicondyle.




Contents

What is Tennis Elbows?

  • Tennis elbow or lateral epicondylitis is an overuse injury which refers to pain over the common extensor tendon origin, i.e. outside of the elbow
  • It is commonly called tennis elbows, due to the high occurrences in tennis players. However people who do not play tennis can also suffer from these pains, e.g. people who partake in gripping tightly or carrying things

What are the common causes?

  • The exact mechanism of this injury can vary from a single violent action to, more commonly, repetitive or overuse injuries, where an action is performed repeatedly and pain gradually develops
  • Overloading the forearm muscles can cause microtrauma of its tendon, leading to tennis elbows

What are the signs and symptoms?

  • Pain or tenderness on the outside of the elbow, it may shoots from the elbow down into the forearm or up into the upper arm
  • Pain when you bend or straighten your wrist and hand
  • Pain made worse by lifting a heavy object
  • Pain when you make a fist, grip an object, shake hands, wring a towel, or turn door handles
  • Curling your wrist upwards with palms downwards against a load
  • Playing tennis or other racquet games, when swinging away from your body, e.g. backarm stroke

What types of treatment are available?

You are encouraged to reduce activity to decrease repetitive loading of the damaged tendon during the initial inflammatory stage. Relative rest prevents ongoing damage, reduces pain and may promote tendon healing. However, complete rest should be avoided to prevent muscular atrophy and deconditioning. Your doctor, occupational therapist and physiotherapist will work together and advise you according to your need

Medication

  • Anti-inflammatory medication during the initial inflammatory stage


Occupational therapy

  • Splinting helps to reinforce rest on wrist extensor muscles
  • Brace helps to redirect pressure away from injured area


  • Your occupational therapist may also advise you on activity modifications or changing the pattern of hand use to minimise strain on the injured tendon


Physiotherapy

  • Your physiotherapist can help you to manage your pain through modalities such as ultrasound therapy or cryotherapy
  • Once pain has subsided, your physiotherapist will advise you on stretching and strengthening exercises. Light loading of the tendon stimulates collagen production and guides normal alignment of newly formed collagen fibres. Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes


Surgical

  • If conservative treatment fails to work for you, your doctor may suggest steroid injection. Nonsteroidal anti-inflammatory drugs (NSAIDs) effectively relieve tendinopathy pain and may offer additional benefit in acute inflammatory tendonitis because of their anti-inflammatory properties
  • When there is no improvement with conservative treatment and/or steriod injection, surgical treatment may be an option

What can I do to help myself?

  • Adequate warm up. Gently stretch your elbow and arm muscles before and after exercise
  • Review your technique. If your condition is sports-related, have a professional to review if you are using proper techniques. For tennis players, it is important to have proper stroke biomechanics and to use quality equipment
  • Avoid grasping objects with your palm down. Lift objects with your palms facing up instead


  • Avoid aggravating the pain. Review your daily activity and list down those activities and movements that aggravate the pain. Make an effort to avoid these activities whenever possible. The activities may include writing, typing, hammering, wringing a towel and lifting a bamboo pole lined with heavy, wet clothes
  • Keep your wrist straight. For example during cooking, you should avoid moving your wrist when stirring food. You should also avoid moving your wrist when you are engaged in lifting tasks or sports. This allows the stronger upper arm muscles to work rather than the smaller forearm muscles
  • Avoid carrying heavy loads. However if you have to carry heavy bags of groceries, you can use larger muscles by looping these bags on your forearm
  • Take frequent short breaks and make use of elbow brace/ splint. If you are unable to avoid the repetitive and forceful use of your fingers and wrist during an activity, you should make an effort to intersperse it with other lighter tasks, or take regular breaks to do some stretches. You can also make use of elbow brace/ splint to unload the tension over your forearm muscles and tendons

FAQs

1. When can I return to my normal activities?

  • Everyone recovers from an injury at a different rate
  • In general, you can return to normal activity when:
    • You are able to forcefully grip things, or do activities such as working at a keyboard without pain in your elbow
    • There is no swelling around your elbow
    • You have regained normal strength and range of motion in your elbow, as compared to your uninjured elbow

2. How long do I have to wear the splint/brace?

  • Splinting is recommended for at least 6 weeks. You should consider using the counterforce brace during sports activities for a minimum period of 6 months

3. Will my symptoms return?

  • Unless you make an effort to change the way you perform your daily activities and work, the symptoms can recur

References

  1. Altan, L. & Kanat, E. (2008). Conservative treatment of lateral epicondylitis: comparison of two different orthotic devices. Clinical Rheumatology 27; 1015-1019.
  2. Bisset, L. et al. (2006). Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ; 1-6.
  3. De Smedt, T. et al. (2007). Lateral epicondylitis in tennis: update on aetiology, biomechanics and treatment. Br J Sports Med, 41; 816-819.
  4. Dunn, J. H., Kim, J. J., Davis, L. & Nirschl, R. P. (2008). Ten- to 14- Year Follow-up of the Nirschl Surgical Technique for Lateral Epicondylitis. The American Journal of Sports Medicine, 36(2); 261-266.
  5. Mayo Foundation for Medical Education and Research (MFMER). (1998-2010). Tennis Elbow. [Online]. Available: https://www.mayoclinic.org/diseases-conditions/tennis-elbow/diagnosis-treatment/drc-20351991 (5 January, 2010).
  6. Stanley, B. G. & Tribuzi, S. M. (Eds.) (1992). Concepts in Hand Rehabilitation. USA: F. A. Davis Company.
  7. The Hand Rehabilitation Center of Indiana. (2001). Diagnosis and Treatment Manual for Physicians and Therapists. (4th ed.) USA: The Hand Rehabilitation Center of Indiana.
- Last updated 23 Jan 2018,2:12 pm




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