Tennis Elbow

Tennis elbow, or lateral epicondylitis, is a condition characterized by persistent outer elbow discomfort due to repetitive arm movements. It involves inflammation of the forearm tendons and can escalate from mild to severe pain if neglected.

Tennis elbow symptoms

Tennis elbow symptoms typically:

  • Develop progressively, with potential sudden flare-ups
  • Include pain roughly 1-2 cm below the elbow’s outer bony part
  • Lead to forearm and wrist weakness
  • Make common tasks like gripping, opening doors, or shaking hands painful

For diagnosis, therapists may employ tests like resisted wrist extension, Mills manoeuver, and neural tension tests.

What is Tennis elbow?

Tennis elbow refers to pain on the elbow’s outside, with precise diagnoses ranging from tendon inflammation (lateral epicondylitis) to tendon wear and tear (tendinopathy). The wrist extensor muscles connect at the elbow’s outer part, where the ‘extensor carpi radialis brevis’ muscle’s tendon is particularly sensitive due to numerous pain receptors. Symptoms can be either acute or chronic.

Acute Tennis elbow

Acute injuries, such as those from poor tennis backhand technique, occur instantly when the extensor muscles at the back of the forearm overload. This results in minor micro-tears in the tendon at the elbow attachment point.

Chronic Tennis elbow

Chronic injuries, typically developing over days or weeks, commonly arise after intense exercise or unfamiliar activities, such as heavy lifting or DIY tasks.

Is it lateral epicondylitis or extensor tendinopathy?

The term “lateral epicondylitis” is frequently used, but can be misleading due to the implied inflammation from the suffix ‘itis’. In chronic cases, the initial inflammation subsides, and the term “tendinopathy” more accurately depicts the tendon’s degeneration.

What causes tennis elbow?

Tennis elbow primarily stems from overuse or repetitive strain, especially frequent wrist extension.

This may involve:

  • Using manual tools, like screwdrivers
  • Engaging in heavy weightlifting
  • Performing repetitive occupational activities, such as lifting bricks

Tennis technique

“Tennis elbow” derives its name from the strain a poorly executed backhand places on the forearm, concentrating force at the elbow’s outer point. This effect intensifies if the wrist is bent during the strike, as forces transmit through muscle and tendon rather than the entire arm. Consequently, proficient players less frequently experience this, thanks to their superior technique and strength.

Factors specific to tennis that exacerbate the issue include:

  • Overly tight racquet grip
  • Excessively taut racket strings
  • Undersized grip

All these factors contribute to overworking the forearm muscles.

Tennis elbow treatment

Effective treatment of tennis elbow involves reducing pain and inflammation, then progressively increasing load through exercise. A holistic approach is recommended.

Immediate First Aid: In the initial 72 hours post-injury, apply P.R.I.C.E (Protection, Rest, Ice, Compression, and Elevation).

Rest: Key to treatment, it can be challenging but vital. Avoid strenuous tasks like lifting heavy objects or playing tennis.

Ice/Cold Therapy: Apply ice or a cold compression wrap for up to 15 minutes to alleviate pain and inflammation. Avoid ice burns by using a wrapped ice pack or commercial cold therapy compression wrap.

Medication: Doctors might prescribe Ibuprofen to lessen pain and inflammation. Note its long-term effectiveness is limited and is not recommended for those with asthma.

Tennis Elbow Brace: This reduces tendon strain and promotes healing by redistributing pressure. A neoprene elbow sleeve can offer general support and retain heat, beneficial for chronic injuries.

Massage: Sports massage, specifically cross friction massage of the tendon, can help chronic cases. Deep tissue massage of the forearm can release knots and lessen stress on the tendon.

Electrotherapy: Therapists may use ultrasound, laser treatments, or Extracorporeal Shock Wave Therapy to address symptoms.

Acupuncture: In some cases, acupuncture can be effective. It involves needle insertion into specific forearm points to modify pain signal transmission.

Corticosteroid Injections: They are effective short-term. However, their long-term effectiveness is debatable, often requiring a series of injections. Steroids should be injected around the tendon attachment and not directly into the tendon to avoid ruptures.

Alternative Treatments:

Nitric Oxide Donor Therapy: Applying patches to the elbow may be beneficial over months, but around 5% of patients may experience headaches or skin rashes.

Botox Injections: These could provide short-term pain relief, but they risk impairing forearm muscle function.

Autologous Blood Injection: This process involves centrifuging a patient’s own blood to extract platelet-rich plasma. Injecting this plasma back into the injury site can potentially stimulate or enhance the healing response.

Tennis elbow surgery

Surgical Intervention and Recovery:

Tennis and golfer’s elbow surgeries share similarities, both involving the removal of the frayed or diseased tendon from the bone. Modern techniques typically employ endoscopic procedures, which allow for smaller incisions.

Recovery Time:

Most cases improve with conservative (non-surgical) treatment. If surgery is necessary, the typical recovery period is around eight weeks.

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