Tennis elbow is also known as lateral epicondylitis and is a condition that involves tendons located around the outside part of the elbow. These tendons attach muscles in the forearm, which extend the wrist and fingers, to the bone. Over time these tendons can become inflamed and tiny micro tears form in the tendons caused by an injury or overuse. This weakens the attachment site and places a strain on the muscles when they try to make a movement.
Although it is called Tennis elbow, not everyone who develops this condition plays tennis. As many as 1 in 3 people have tennis elbow at some time in their lives but it is most common in the 40-60 age group.
It is more common in the dominant hand and this is because it is often caused by muscles repeatedly moving and therefore tugging at the tendon attachment site near the elbow. Occupations more at risk are those that involve bending and extending the wrist while rotating the hand. Therefore it is seen in plumbers, electricians, waitresses and nurses.
Generally people complain of pain around their elbow, usually on the bony point just above the outside of the elbow called the lateral epicondyle.
The area may be tender to touch and the pain can be worse after inactivity or when tightly gripping and twisting objects. It can lead to wrist weakness and difficulty performing normal activities of daily living, such as lifting a cup of tea, opening a jar, writing or brushing teeth.
Chronic tennis elbow can cause a aching pain on the upper arm too, and an increased sensitivity to pressure or touch in this area.
Tennis elbow cannot be diagnosed from blood tests and rarely by X-rays. Rather it is usually diagnosed by the description you give of your pain and what movements cause it to your doctor or Hand therapist and by a physical examination of your arm.
The type of treatment recommended for tennis elbow will depend on several factors including age, type of other medications being taken, overall health, medical history and severity of pain. The goals of treatment are to reduce pain or inflammation, promote healing and decrease stress and abuse of the injured elbow, and allow full use of the arm.
Conservative (nonsurgical) treatment from your GP can include anti-inflammatory medications and steroid injections into the painful area if the condition does not improve by itself after 4 months.
However, the evidence for steroidal injection is poor as the recurrence rates for tennis elbow are high using this form of treatment alone. The side effect of tendon detachment is high for tennis elbow using steroidal injection. Despite this, steroid injection may be repeated up to 3 times before your GP will refer you to a hospital consultant for specialist treatment from a Hand therapist prior to surgery.
If the condition is new to you then using R.I.C.E. steps can help:
Rest: The tendons need rest to allow healing to take place. Tendon fibres that are injured need to stay still as newly healing fibres are fragile.
Ice: Put an ice pack on the elbow for up to 20 minutes every 2 to 3 hours to reduce swelling (you could use a bag of frozen peas wrapped in a tea-towel).
Compression: Use a sports support to help reduce swelling. Learn from your Hand therapist how to apply sports tape to off-load the damaged tendons
Elevate: Take an opportunity to raise the arm above your head as often as you can.
Performing range of movement exercises to reduce stiffness and increase flexibility helps so long as these don't cause any discomfort.
With surgery, the damaged section of tendon is removed and the remaining tendon repaired. Occasionally people with tennis elbow eventually need this treatment. Surgery is estimated to work in 80%-90% of cases.
Tennis elbow can be successfully treated but like most conditions caused by overuse or injury, early intervention is importants for the best outcomes. A hand therapist can provide non-surgical management for the treatment of tennis elbow, with the goal to return the patient back to normal work, home and sports activities. This includes:
- Custom fabricated wrist orthosis to prevent moving the muscles and tendons involved for 6 - 8 weeks.
- Sports taping to reduce tendons tugging at the attachment site.
- Cortical re-mapping of movement to ensure new pain free movements are encouraged to replace the injured ones
Crucial to successful outcomes from treatment is the identification of activities in work or home that might aggravate symptoms. At Hand Kinetics you can expect a full evaluation of your movement technique and advice on how to make modifications to prevent recurrence.
Various other treatments can be utilised, such as heat, ice, ultrasound, massage or electrical stimulation. The therapist will often prescribe stretching and strengthening exercises as part of your home exercise programme.
Following any surgery for tennis elbow, therapy is important to regain motion and strength.
Hand Kinetics Telephone: 0044 28 417 72301
www.handkinetics.com
contactus@handkinetics.com
