Are you at risk of tennis elbow?

Introduction

Tennis elbow is a common condition which affects 1-3% of the general population across the world. Classically, it occurs between the ages of 35-55 years and is equally prevalent in both the sexes, male and female. It mainly occurs due to the gripping activities and resisted or repetitive movement. Tennis elbow is also termed as lateral Epicondylitis.

The patient with Tennis elbow feels a sense of weakness when lifting even small objects. There is tenderness (pain or discomfort) over the lateral epicondyle region, but the movements of the elbow and wrist joints are normal. It often follows an injury or sudden contraction of the common extensor origin.

Causes of Tennis Elbow:

Usually, the area of tennis elbow includes the region, where both the tendon and muscle adhere to the outside bony area. The exact cause is not known. But, it is believed that the condition may occur due to the inflammation or tear of the fibers or tendons of the extensor muscles. Mostly it is caused by the abrupt injury.

According to the Journal of Primary Health Care, the condition may occur due to the degeneration of the extensor muscle triggered by the repeated stretching through tendinopathy. It mostly impacts on the tendons and causes a microscopic tear of them. As a result, it may cause the formation granulation tissue and fibrosis.

Other factors:

Lack of forearm strength and endurance

Age

Musculotendinous inflammatory abnormalities such as,

1. Epicondylitis: This is due to single or multiple tears in the common extensor origin, periostitis, proliferation of extensor carpi radialisbrevis(ECRB), etc.

2. Inflammation of the adventitious bursa: Between the common extensor origin and radiohumeral joint.

Calcification in the common extensor tendon.

Painful annular ligament: It is due to hypertrophy of synovial fringe between the radial head and capitulum.

Pain of neurological origin.

Individuals in Greater Risk:

The lateral Epicondylitis is triggered by the overuse and imbalance of the elbow muscle. Therefore, it mostly occurs in the people with jobs or service that involves repetitive manual tasks, such as:

Medical professionals like Nurses

Office employees who continuously work with computer

Players exposed to prolong weight

Household activities like cooking, cleaning, sweeping, painting, typing, etc.

1/3 of the Tennis players across the world, above 35 years. Interestingly, the incidences of the condition are reduced in the tennis players nowadays, because of the use of lighter rackets and backhand techniques of stroke.

Symptoms of Tennis Elbow:

Tennis elbow symptoms include:

The pain slowly increased around the lateral side of the elbow joint, which may develop suddenly.

Pain worsens during shaking hands or squeezing any objects.

Pain becomes severe by wrist extension or moving it with force. For example, lifting, using tools, opening jars, toothbrush, or even handling simple things such as, a knife and fork.

Diagnosis of Tennis Elbow:

The investigation of tennis elbow can be done by the following diagnostic tests:

X-Ray or MRI scan in order diagnose severe ailments such as arthritis or any injury inside the elbow.

If a person has chronic tennis elbow that fails to heal, an MRI scan, or an ultrasound scan can be taken. MRI or ultrasound will produce a more detailed image than an X-ray, as it includes the images of the muscles and tendons inside the arm.

Clinical tests:

Local tenderness on an elbow at the common extensor origin with the aching pain in the back of the forearm.

Painful resisted extension of the wrist with anelbow in full anextension aggravates pain to the lateral elbow (cozens test).

Treatment of Tennis Elbow:

Tennis elbow can be managed by the following way:

Conservative management:

Proper rest

Pain killers: Painkillers or analgesics like non-steroidal anti-inflammatory medicines such as Ibuprofen and Aspirin can be prescribed to reduce the pain and swelling.

In tennis players: Exercises, light racket, smaller grip, elbow strap, etc. works excellent.

Injection of local anesthetic and steroid are useful in 40% of cases.

Icing or ice therapy decreases pain and swelling

Exercise: To restore the normal muscle length, strength and movement patterns.

Physiotherapy management

The following measures are used in physiotherapy toreduce the pain:

During acute phase:

Rest: An above elbow pop splint with anelbow in 90 degrees flexion and supination and the wrist in slight dorsiflexion position is recommended.

Thermotherapy: The heat modalities like ULTRASOUND and SWD works great in reducing the elbow pain.

Cryotherapy: Ice or cold packs on the tender area for a period of 15-20 minutes is very effective to reduce the pain in the elbow.

Electrical stimulation: This is recommended for 15-20 min with the arm little elevated. It reduces the pain and inflammation.

Exercises:

Active exercises for the shoulder, elbow, wrist and hand are indicated.

Isometrics also help improve the stability.

Progressive resisted exercises for wrist extension, lateral deviation, forearm supination and finger flexion (Dumbbells of 0.5 to 2kg) are used to improve muscle strength.

Manipulation this is practiced in certain situations and not commonly done.

Post-acute phase

The patient is instructed to avoid repeated wrist extension and supination movements.

Strengthening exercises to the extensor carpi radialisbrevis muscle, supinator muscle, and common extensor group of muscles after an adequate period of rest and support during the acute phase.

Exercises:

Passive exercises: In the supine position, relaxed, passive movements of the elbow (flexion) and forearm (supination) are carried out in its complete range.

Resistive exercises: When a painless range of movements are achieved by the passive exercises, then resisted exercises are advised.

Strengthening exercises: Strong isometrics to the triceps, to improve the range of motion. Exercises to the wrist and fingers are also advised.

Surgical management

Indications:

In case of severe pain for 6 weeks at least

Marked localized tenderness over the lateral epicondyle

Failure to respond to the restricted movement or immobilization for at least 2 weeks.

Surgical methods

Release of epicondylar muscles

Arthroscopic release of the common extensor muscles origin from lateral epicondyle is the best surgical option of choice due to its minimal exposure and effectiveness.

Physiotherapy after surgery

Measures to control pain as mentioned earlier.

Exercises to the shoulder to regain the range of motion

Passive range of motion exercises is also useful for the shoulder, elbow, forearm and wrist.

Progressive resisted exercises as mentioned earlier.

Thermotherapy helps reduce pain.

Significant relief of symptoms in tennis elbow

Changing tennis strokes - 92%

Stretching exercises - 84%

Use of splints - 83%

NSAIDS/steroids - 85%

Physiotherapy - 50-75%

Rest more than one month - 72%

PROGNOSIS

Untreated Tennis Elbows can last from 5 months to 2 years. And it is more prone to relapse.

Recent studies have declared that physiotherapy is the most effective way of managing tennis elbow when compared to steroid injections or other treatment.

Most of the patients show significant improvement with a 6-week course of physiotherapy treatment comprising 8 treatment sessions. The improvement is shown to continue up to 90% of improvement for a period of 12 months of therapy, even without having the further treatment.