WHAT IS IT?

Tennis elbow, or lateral epicondylitis is characterised by pain along the outer border of the elbow, often associated with gripping tasks. Tennis elbow occurs when there is a problem with the tendons that attach to the bony point on the outside of the elbow. These tendons are the attachment of the muscles that function to cock the wrist back. Specifically, the extensor carpi radialis brevis has been implicated in causing the symptoms of tennis elbow. This muscle attaches to a part of the elbow bone called the lateral epicondyle, thus giving tennis elbow the medical name ‘lateral epicondylitis.’ Tennis elbow is not simply an “inflammation” of these tendons. The problem is thought to be a degenerative process as a result of repetitive use. This process occurs when microscopic tears are incompletely healed within the tendon.

WHO GETS IT?

Tennis elbow is more prevalent in individuals over 40, where there is about a 4-fold increase amongst men and 2-fold increase amongst women

WHY – RISK FACTORS?

  • Over 40’s; peak
  • Physical work including strong gripping actions in the hand, repetitive elbow movements
  • Men> women
  • Usually affects the dominant arm

WHAT STRUCTURES ARE INVOLVED? 

Tendons (join muscle to bone) which attach to the outside of the elbow. These are the attachement of the muscles that cock the wrist back. The extensor carpi radialis brevis has been implicated in causing the symptoms of tennis elbow

SYMPTOMS?

  • Pain over the outside of the elbow
  • Pain with gripping, even minor weights e.g. cup of coffee
  • Pain and weakness with shaking hands
  • Swelling in the outside of the arm
  • Weakness in the elbow, wrist and hand
  • You will often ignore this discomfort thinking “ it will get better and go away” Two weeks later you may have this same conversation with yourself. 4-6 weeks later you will realise the symptoms are getting worse and you better do something about it. Our experience is that most women seek professional advise from either their Doctor or Physio, whilst most men wait another 4-6 weeks and just put up with it until their pain is intollerable and they have gross weakness in the arm.

MANAGEMENT

Stage 1: Stop it getting worse

(A)   Stop the aggravating factors. The “no pain no gain”  theory doesn’t work here.  Rest and ice are good starting points. Often it is vital to give careful thought to the possible aggravating factors such as repetitive gripping, forceful elbow movements and easing back or stopping these activities

(B)   Accurate assessment and diagnosis of the issue is essential. Other potential complicating factors can include cervical spine (neck) issues, nerve injuries ( radial or median nerve) and shoulder injuries.

Stage 2: Rehabilitation:

Time frames are very dependent upon the time the symptoms have been present before treatment is initiated. In general terms, if you have symptoms for 6 weeks or less then expect successful treatment to be concluded within 6 weeks. If you leave it longer than this then double your time frame, i.e if the symptoms have been present for 2 months then expect a 3 -4 month rehabilitation process.  Your treatment is likely to involve the following: 

(a)Manual Therapy

Our Physiotherapists will accurately assess your arm and formulate the best combination of manual therapy approaches. These may include:

  • Elbow joint mobilisation/ manipulation
  • Soft tissue massage/ releases
  • Dry needling                     

(b) Electrotherapy

A variety of electrotherapeutic approaches can be useful to help reduce swelling, improve circulation and reduce muscle tension. These can include:

  • Ultrasound
  • Interferential therapy
  • Heat/ wheat packs
  • Ice 

(c) Stretches

Stretches can occur once the acute inflammatory process is addressed and must not aggravate the injury/ symptoms. Our Physiotherapists will advise you when and how to stretch effectively. Both muscle stretches and nerve mobility stretches are important in the resolution of symptoms. 

(d) Strengthening

Muscles become weak and lose size quickly. Strengthening exercises are often performed early in the rehab process but must be managed carefully

(e) Use of Braces

Tennis elbow braces can be a useful adjunct to a management approach. They work by taking the pressure off the tendon attachment to the bone.  

(f) Cortisone injections 

We field many questions regarding the use of these powerful anti-inflammatory and pain killing injections. Many patients have had good success with this appraoch, others have reported very short term effects with the injection masking the pain arising from the resultant tendon damage.

Stage 3: Return to activity

This is a crucial stage. It is important that this be in a graduated fashion and must be PAINFREE.

 

Stage 4: Prevention of recurrence

This step involves identification of the root cause of your symptoms and modification of the task or activities so that the risk factors are eliminated or minimised. Successsful strategies can include changing the task to significantly change the manual work demands, adding lifting devices or machinery. If this is not possible then administrative controls such as job or task rotation can be utilised.

 

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