Tennis Elbow

WHAT IS IT?

  • Inflammation of the forearm and wrist muscles / tendons that attach to the bone on the outside of the elbow ~ the lateral epicondyle

HOW DO THE MUSCLES AND TENDONS WORK?

  • extend the wrist and fingers, as well as contract when making a fist, lifting, or carrying things
  • turn forearm up ~ ‘palm up’ position termed supination

WHAT HURTS?

  • tender lateral epicondyle ~ bony point on outside of elbow
  • may have radiating pain into the forearm
  • pain on grasping, squeezing, or lifting objects
  • pain when bending and straightening elbow, and when rotating forearm
  • pain with repetitive use at home or work for example painting, hammering, cleaning, computer work, writing.
  • pain is NOT limited to tennis players or athletes!

WHAT SHOWS UP ON X-RAY?

  • usually nothing
  • calcium deposit in advanced stage only occasionally
  • arthritic changes at the lateral elbow joint where the radius meets humerus - not often

WHAT CAUSES IT?

  • overuse, sport or daily activity related
  • weak forearm muscles or imbalance between flexor and extensor muscle groups
  • inadequate flexibility or endurance
  • improper stroke technique - use of arm instead of body
  • novice player more at risk
  • equipment error - heavier, stiffer racquet, grip size, too tight stringing
  • direct trauma
  • cervical spine nerve pinching
  • adverse neural tension ~ lack of mobility of nerve tissues
  • residual dysfunction of other upper extremity joints

WHY DOES IT HURT?

  • muscle and tendon overexertion causes pulling of tendon from bone
  • microtearing of tendon, inflammation, scar tissue formation and shortening of tendon
  • becomes easier and easier to tear or re-injure unless treated properly
  • poor nutrition from the nerve to the lateral epicondyle also causes tendon degeneration and pain

WHAT DO I DO?

  • rest from painful activities and apply ice or heat depending on situation and condition
  • analyze cause, address biomechanical causes with appropriate stretching of shortened or stiff structures and strengthening of relatively weak areas as outlined by your physiotherapist
  • correct equipment and technique errors
  • use of a brace to minimize stress on the injured area
  • use of ice in acute, more painful conditions
  • deep transverse friction massage breaks down scar tissue, relieves pain, and promotes healing if done properly and at the right time
  • anti-inflammatory medication, if necessary, as prescribed by your physician
  • therapeutic modalities: ultrasound, interferential current, etc...
  • cortisone injection ~ only if necessary, by your physician

HOW DO I PREVENT IT?

  • avoid overuse be smart and gradually increase intensity, frequency, and duration of play
  • avoid technique errors - get a lesson or two!
  • make sure equipment is adequate - get a ‘tune-up’ if necessary
  • improve flexibility and strength of forearm muscles
  • maintain mobility of all upper extremity joints, including wrist, shoulder, and neck too!

WHAT ELSE CAUSES PAIN IN THIS AREA?

  • joints of the cervical and upper thoracic spine
  • muscles of the shoulder region
  • elbow ligaments
  • elbow joint arthritis
  • nerve entrapment ~ pinched nerve
  • adverse neural tension in the upper extremity
  • periostitis ~ inflammation of the bone
  • bursitis at the elbow
  • rheumatoid arthritis, gout and other systemic disorders

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…

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