Tennis Elbow Management and Treatment

Elbow pain

What is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow, also known as lateral epicondylitis, is a condition characterised by elbow pain and inflammation on the outer part of the elbow. Despite its name, it is not limited to tennis players and can affect anyone who repeatedly uses their forearm muscles. The condition is caused by repetitive motion and overuse of the muscles and tendons that connect to the lateral epicondyle, which is the bony prominence on the outer side of the elbow.

Anatomy of the Elbow:

The elbow joint is a complex structure that connects the upper arm bone (humerus) to the two forearm bones, the radius and ulna. It is a hinge joint that allows for bending and straightening of the arm, as well as some rotational movements. Several important anatomical structures contribute to the function and stability of the elbow. Here are the key components of the elbow anatomy:

The humerus is the long bone of the upper arm. At the distal end of the humerus, there are two bony protrusions called the medial epicondyle and the lateral epicondyle, which provide attachment sites for muscles and ligaments.

The ulna is one of the two forearm bones. It runs along the inner (medial) side of the forearm and forms the bony prominence of the elbow called the olecranon process, which can be felt at the back of the elbow.

The radius is the other forearm bone. It runs along the outer (lateral) side of the forearm and connects to the wrist joint.

The ends of the humerus, ulna, and radius are covered with smooth cartilage, which allows for smooth movement and cushions the joint.

The elbow joint is surrounded by a fibrous capsule that helps stabilize the joint and contains synovial fluid, which lubricates the joint.

Several ligaments provide stability to the elbow joint. The ulnar collateral ligament and radial collateral ligament are on the inner and outer sides of the joint, respectively, and help prevent excessive sideways movement. The annular ligament encircles the head of the radius and holds it in place.

Both the upper arm and forearm muscle around the joint play a crucial role in its movement. The biceps and triceps muscles, located in the upper arm, are responsible for flexing and extending the elbow, respectively. The forearm muscles, such as the flexor and extensor muscles, control movements of the wrist and fingers and also contribute to the movement of the elbow.

Bursae are fluid-filled sacs located around joints to reduce friction. In the elbow, there are several bursae, including the olecranon bursa, which cushions the bony olecranon process.

Understanding the anatomy of the elbow helps in diagnosing and treating various conditions and injuries that may affect this joint.

 

Causes of Tennis Elbow (Lateral Epicondylitis):elbow pain

The primary cause of tennis elbow is repetitive or strenuous activities that involve gripping, twisting, or extension of the wrist. These actions strain the tendons that attach to the lateral epicondyle, leading to small tears and inflammation. Some common activities that can contribute to tennis elbow include racquet sport activities such as playing tennis (hence the name), other racquet sports, golf, weightlifting, typing, painting, gardening, and repetitive hand or wrist movements in various occupations.

 

 

Symptoms of Tennis Elbow (lateral Epicondylitis):

The main symptom of tennis elbow pain and tenderness is on the outer side of the elbow, which may gradually worsen over time. The arm pain may radiate down the forearm and worsen with activities that involve gripping or wrist movement. Other symptoms can include weakness in the forearm, elbow weak grip strength, and pain or discomfort when extending the wrist fully and forearm muscles extend.

Management of Tennis Elbow:

The management of tennis elbow (lateral epicondylitis) involves a combination of conservative treatments aimed at reducing pain, promoting healing, and preventing further injury. Here are some common approaches to managing tennis elbow:

Rest and Modification of Activities:

Resting the affected arm and avoiding activities that exacerbate the pain is crucial. Modify or reduce the intensity of activities that involve gripping, twisting, or repetitive wrist movements.

Ice Therapy:ice therapy

Applying ice packs or cold compresses to the affected area can help reduce pain and inflammation. Apply ice for 15-20 minutes several times a day, especially after activities or when pain flares up.

Pain Relief:

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may help alleviate pain and reduce inflammation. Follow the instructions and consult a healthcare professional if needed.

Physiotherapy:

Tennis elbow physiotherapy involves a physiotherapist providing specific clinical exercises and techniques to promote healing to treat tennis elbow, strengthen the forearm muscles, improve flexibility, and restore range of motion. Eccentric exercises, where you gradually lengthen the involved tendon under resistance, have shown effectiveness in managing tennis elbow (2).

Bracing or Splinting:

Wearing an elbow brace or forearm strap can help relieve stress on the affected area and provide support during activities. These devices may help reduce pain and improve function.

Corticosteroid Injections:

In some cases, corticosteroid injections may be recommended if conservative treatments have not provided sufficient relief for your tennis elbow. These steroid injections can help reduce inflammation and pain, but are generally limited to a few treatments due to potential side effects.

Extracorporeal Shock Wave Therapy (ESWT):

ESWT involves the use of high-energy sound waves to stimulate healing. It may be considered for persistent cases of tennis elbow that haven’t responded to other treatments. Extracorporeal Shockwave Therapy (ESWT) is a non-invasive medical treatment that has been used for various musculoskeletal conditions, including tennis elbow (lateral epicondylitis). ESWT involves the application of high-energy shockwaves to the affected area, promoting tissue healing and reducing pain.

The effectiveness of ESWT for tennis elbow is still a topic of ongoing research, and its use may vary among healthcare providers. Some studies have shown positive outcomes (1), while others have reported mixed results. It’s important to consult with a healthcare professional experienced in ESWT to determine if it’s a suitable treatment option for your specific case.

It’s worth noting that ESWT is not the only treatment available for tennis elbow. Other conservative approaches, such as rest, physical therapy, bracing, anti-inflammatory medications, and corticosteroid injections, are commonly used. In more severe cases that do not respond to conservative measures, surgery may be considered.

Platelet-Rich Plasma (PRP) Therapy:

PRP involves injecting a concentrated solution of your own blood platelets into the affected area to promote healing. It is an emerging treatment option for tennis elbow but may require further research to establish its effectiveness.

Making ergonomic adjustments to your workspace or equipment can help reduce strain on the forearm muscles provoking your tennis elbow. This may involve using ergonomic keyboards, adjusting desk height, or improving grip techniques.

Gradual Return to Activity:

Once the pain has subsided and the tennis elbow improves, gradually reintroduce activities and sports, ensuring proper warm-up, stretching, and using appropriate techniques to minimise the risk of recurrence.

It’s important to note that the effectiveness of different treatments may vary from person to person. Consulting a healthcare professional, such as a doctor or physical therapist, can provide a tailored management plan based on your specific condition and needs.

elbow rehabTreatment Options for Tennis Elbow:

Treatment for tennis elbow pain usually involves a combination of rest, pain management, and physiotherapy. Initially, it is important to rest the affected arm and avoid activities that worsen the pain. Applying ice packs, taking over-the-counter pain relievers, and using braces or supports to relieve stress on the affected area may help alleviate symptoms.

Physiotherapy exercises are often prescribed to strengthen the forearm muscles, improve flexibility, and promote healing for tennis elbow. In some cases, corticosteroid injections may be used to reduce inflammation and alleviate pain. Tennis elbow surgery is rarely required and typically reserved for severe, chronic cases that don not respond to conservative treatments.

Gradual strengthening exercises can be an effective component of the rehabilitation process for tennis elbow. These exercises aim to progressively strengthen the muscles and tendons surrounding the elbow, improving their resilience and reducing the risk of further injury. Here are some examples of graduated strength exercises for tennis elbow:

Wrist Extension: Start with your forearm resting on a table or your knee, palm facing down, and a lightweight dumbbell in your hand. Slowly lift the weight by extending your wrist, keeping your forearm still. Lower the weight back down in a controlled manner.

Start with a light weight and gradually increase the resistance as you build strength. Aim for 2-3 sets of 10-15 repetitions.

Wrist Supination and Pronation: Hold a light dumbbell or a hammer in your hand, with your forearm supported on a table or your knee and your palm facing upward. Slowly rotate your wrist outward (supination) as far as you can comfortably go. Return to the starting position and then rotate your wrist inward (pronation) as far as you can comfortably go.

Perform 2-3 sets of 10-15 repetitions.

Eccentric Wrist Flexion: Hold a lightweight dumbbell or a resistance band in your hand, with your forearm supported on a table or your knee and your palm facing upward. Slowly lower the weight by flexing your wrist, resisting the motion with the unaffected hand. Use your unaffected hand to assist in bringing the weight back to the starting position.

Perform 2-3 sets of 10-15 repetitions.

Isometric Wrist Extension: Place your forearm on a table or your knee, palm facing down. Rest your hand and the affected side of the forearm against the surface. Push your hand and forearm down against the surface, engaging the muscles in your forearm.

Hold this position for 10-15 seconds, then release. Perform 2-3 sets of 10-15 repetitions.

Remember, it is important to start with light resistance and gradually increase as your strength improves. If any exercise causes your pain or discomfort to worsen, stop immediately and consult with your treating physiotherapist. Additionally, combining these exercises with other treatment modalities, such as rest, ice, and stretching, can enhance the overall rehabilitation process. A qualified physiotherapist can provide personalised guidance and recommendations based on your specific needs.

How can we help at Lilyfield Physio:

If you feel you are developing symptoms of tennis elbow or want to prevent tennis elbow developing, we are here to help. We have an experienced team to help you from developing tennis elbow and further arm pain from repetitive arm movements. We understand the nature of overuse injury and can help to relieve symptoms with a good rehabilitation program to strengthen your injured tendon.

If you have a repetitive injury causing painful symptoms, get in touch!

References:

1) A comparative study of the efficacy of ultrasonics and extracorporeal shock wave in the treatment of tennis elbow: a meta-analysis of randomized controlled trials Chenchen Yan, Yuan Xiong, Lang Chen, Yori Endo, Liangcong Hu, Mengfei Liu, Jing Liu, Hang Xue, Abudula Abududilibaier, Bobin Mi & Guohui Liu Journal of Orthopaedic Surgery and Research volume 14, Article number: 248 (2019)

2) A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy) Magnus Peterson, Stephen Butler, […], and Kurt Svärdsudd Clinical Rehabilitation Volume 28, Issue 9

 

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