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Tennis Elbow, Elbow Pain, Overuse of the Elbow, Lateral Epicondylitis

Tennis elbow is the commonest overuse-type injury of the elbow and about ten times more common than the related golfers elbow. The medical term is lateral epicondylitis.

Tennis elbow is very common, with 4-7 patients per 1000 presenting in primary care in the UK every year. Unfortunately, while treatment can be successful, the problem tends to recur. A really effective treatment has not been found.

Recent research has shown physiotherapy to be the most effective treatment for tennis elbow pain (at 12 weeks and continuing up to year) and you should consult a physiotherapist for skilled assessment and management. Elbow manipulation and exercise from a physio was shown to be more effective in the shorter term than doing nothing or having steroid injections, although there was no difference at a year.

Causes of Tennis Elbow

Tennis elbow has always been viewed as caused by inflammation of the tendons on the outside (lateral side) of the elbow at a bony prominence called the lateral epicondyle. The tendons are the attachment to the bone of extensor carpi radialis brevis, one of the muscles which extends and stabilizes the wrist.

However, the understanding of disorders of tendons has advanced greatly with recent scientific research. The idea of inflammation has been replaced by a concept of tendon degeneration under physical stress and the subsequent inadequate repair.

Overuse of the muscles on the back of the forearm by various repetitive movements of the wrist and hand can cause tennis elbow pain. Tennis players are not the most common sufferers of this problem.

Overdoing many activities can cause tennis elbow, such as cleaning windows, hammering and screw driving, repetitive holding or gripping of a tool, or even tennis. Poor technique in tennis can increase the likelihood of developing tennis elbow, although the size of the racquet handle has not been shown to be a risk.

Symptoms of Tennis Elbow Pain

The person usually describes the following:

  1. Gradual onset of pain on the outside of one elbow. It can be sudden at times if the person overdoes an activity very greatly.
  2. The pain is achy and worsens with activity, sometimes even lifting small weights.
  3. The pain can be very disabling if severe, inhibiting the use of the hand for any activity demanding even moderate strength.

Treatment for Tennis Elbow Pain

Physiotherapy is the most useful treatment option for this kind of elbow pain. Your physio will initially aim to reduce the pain and potential inflammation if you are in an acute episode.

Anti-inflammatory treatments include ice, ultrasound, and a wrist splint to rest the muscles. A tennis elbow strap (epicondylitis clasp) can also be used to attempt to reduce the load on the area of muscle attachment at the elbow. Deep tissue and friction massage techniques can also be used to break down underlying adhesions and improve the local circulation.

Once the acute stage has settled the aim is to restore function of the involved muscles by a graded exercise plan targeting the flexibility, strength, and endurance of the wrist extensor muscles. Your physiotherapist will advise you on this.

The new research however is starting to move us in a different direction. Treatment of inflammation makes less sense if there cannot be shown to be any. Stretching and progressive loading of the extensor muscle in an eccentric manner is the current best practice.

Eccentric in this case means the exercise is done in a manner which allows the muscle to lengthen at the same time. A bit like having a dumbbell in your hand curled up to your shoulder and letting it down repeatedly as the exercise.

Preventing Tennis Elbow Pain

The chances of acute tennis elbow (over last three months) settling down in good but some cases may take years and still be of some trouble even then. Readjustment of the individual’s activities is vital in these cases and an analysis of work postures and physical demands may be useful. The job or other activity may need to be modified to reduce the stress through the forearm muscles and allow the condition to settle.

Jobs such as bricklaying and other activities demanding a high level of strength repeatedly from the hands reduce the likelihood of the problem settling down.

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