Tennis Elbow

What is tennis elbow?

Tennis elbow is a painful elbow disorder. This term is misleading because most people who have it did not get it from playing tennis. In fact, tennis elbow seldom has any connection with fun and games.

The elbow joint is made up of the bone in the upper arm (humerus) and the lower arm (ulna). The bony prominents at the bottom of the humerus are called epicondyles. The prominent site on the outer side of the elbow is called the lateral epicondyle. Forearm muscles are attached by tendons to the epicondyles.

Lateral epicondylitis (tennis elbow) is the name for a condition in which the bony bump at the outer side of the elbow is painful and tender.

Lateral epicondylitis is also referred to as wrist extensor tendinitis. It is actually a tendinitis of the muscle called the extensor carpi radialis brevis which attaches to the lateral epicondyle of the humerus.

It is important to have the neck examined as well as elbow pain can be referred from problems in the neck.

Pathology

The pain from tennis elbow comes mainly from injured or damaged tendons near the elbow. Tendons are strong bands of tissue that connect muscles to bones. When repeatedly stressed or overused, tendons can become inflamed. This results in a painful condition called tendonitis.

epeated, minor tears in the tendon tissue cause pain. Among the activities that can cause tennis elbow are tennis and other racket sports, carpentry, machine work, typing, and knitting.

After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.

Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.

Many medical textbooks treat tennis elbow as a form of tendonitis, which is often the case, but if the muscles and bones of the elbow joint are also involved, then the condition is called epicondylitis. However, if you feel pain directly on the back of your elbow joint, rather than down the outside of your arm, you may have bursitis, which is caused when lubricating sacs in the joint become inflamed. If you see swelling, which is almost never a symptom of tennis elbow, you may want to investigate other possible conditions, such as arthritis, infection, gout or a tumor.

Risk factors

Tennis elbow is associated with jobs that require repeated or forceful movements of the fingers, wrist, and forearm. It can develop because of too much force at once or small amounts of force for too long a period.
Specific movements associated with the development of tennis elbow include:

• simultaneous rotation of the forearm and bending of the wrist,
• stressful gripping of an object in combination with inward or outward movement of the forearm,
• jerky, throwing motions,
• movements to hit objects with the hand.

Signs and symptoms

The symptoms of tennis elbow are:

Rehabilitation Program:

Successful Treatment for Trigger Finger:

• pain or tenderness on the outer side of the elbow
• pain when you straighten or raise your wrist and hand
• pain made worse by lifting a heavy object
• pain when you make a fist, grip an object, shake hands, or turn door handles
• pain that shoots from the elbow down into the forearm or up into the upper arm.
• the lateral epidcondyle and the radial head was tender,
• passive stretching of the common extensor tendon was painful
• resisted muscle test of wrist extensor was painful
• Recurring pain on the outside of the upper forearm just below the bend of the elbow; occasionally, pain radiates down the arm toward the wrist.
• Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.
• Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).
• Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.
• difficulty holding onto, pinching, or gripping objects
• pain, stiffness, or insufficient elbow and hand movement
• forearm muscle tightness
• insufficient forearm functional strength
  

Diagnosis

Diagnosis of tennis elbow includes the individual observation and recall of symptoms, a thorough medical history, and physical examination by a physician. Diagnostic testing is usually not necessary unless there may be evidence of nerve involvement from underlying causes. X rays are usually always negative because the condition primarily affects soft tissue, in contrast to a bony disorder.

Prognosis

Tennis elbow is usually curable; however, if symptoms become chronic, it is not uncommon for treatment to continue for three to six months.

Treatment

1. Rest
2. Avoid further overuse
3. Physiotherapy
   - ice therapy
   - ultrasound
   - acupuncture
   - stretching to  flexibility
   - muscle strengthening & rebalancing
   - improve general fitness
   - Ergonomic advice in work & sports
   - Splintage
4. Wear a tennis elbow strap. This strap wraps around the forearm below the elbow and helps keep the forearm muscles from pulling on the painful epicondyle.

	Stretching exercise Gentle stretching exercises including wrist flexion, extension and rotation.
Strengthening exercise Wrist Extension

In theory, the brace constrains full muscle expansion when the muscle contracts, diminishes muscle activity, and therefore the force generated by the muscle. An analogy is the fret on a guitar; when you exert pressure on a different fret along the neck of the guitar, it changes and reduces the tension on the guitar string above where the pressure is exerted.

Prevention

Until symptoms of pain and inflammation subside, activities requiring repetitive wrist and forearm motion should be avoided. Once pain decreases to the point that return to activity can begin, the playing of sports, such as tennis, for long periods should not occur until excellent condition returns. Many times, choosing a different size or type of tennis racquet may help. Frequent rest periods are important despite what the wrist and forearm activity may be. Compliance with a stretching and strengthening program is very important in helping prevent recurring symptoms and exacerbation.