Tennis Elbow
 Lateral
epicondylitis or tennis elbow, is a tendon injury common in sports and
work activities that require repetitive gripping and lifting.
Most patients are between the ages of 30 and 55, and many have poorly
conditioned muscles.
In addition to occurring with
racket sports, tennis elbow also affects industrial workers whose jobs
require repeated wrist movements and/or gripping. People who carry
large heavy briefcases also are often affected.
Becoming aware of the typical
causes of lateral epicondylitis and the presenting symptoms
is essential for successful treatment. Because recovery can
be prolonged, it is important that the patient be dedicated
to correcting the underlying problems. Early rehabilitation is
important for the prompt return to activity and for reducing risks of
prolonged recovery.
Clinically, tennis elbow
causes pain at the outside of the elbow that may radiate toward the
wrist. Weakness of grip and tenderness at the extensor tendon origin
are also clues to the disorder. While the onset of pain may be acute or
gradual, it usually occurs within 24 to 72 hours after the provocative
activity.
In racquet sports poor body
mechanics, especially when setting up a backhand shot, may
contribute to the problem. If the elbow leads the rest of the forearm
in the backhand stroke, forces to the extensor group of muscles are
excessive. Many of these patients are middle aged athletes who tend to
lack the tissue resiliency of their younger years. As a result, poorly
conditioned muscles surrounding the elbow are overused. These players
are often novices who hit off centre shots with excessive rotational
torque to the racket, placing increased demand on the extensor
musculature.
Actual rupture of the muscles
from the elbow is rare. A more common cause of pain is a microscopic
tear, usually in the origin of the extensor carpi radialis brevis
muscle. Fibrosis and granulation tissue may then develop because of the
repetitive trauma. The other extensor muscles of the forearm are
occasionally involved as well.
Other possible causes of elbow
pain are bursitis, chronic irritation of the radiohumeral joint
capsule, chondromalacia of the radiocapitellar joint, involvement of
the orbicular ligament of the radius, periosteal avulsion
with myositis of the extensors, cervical radiculopathy, and radial
nerve entrapment, and must be ruled out by your family doctor and
physiotherapist.
Management of tennis elbow
begins with rest and avoidance of any activities that lead to pain.
Activities should be avoided for as long as acute pain persists or
until provocative activities become tolerable. Inflammation needs to be
controlled through the use of ice, physical therapeutic modalities such
as ultrasound, and possible antiinflammatories. Stretching and
strengthening as directed by your physiotherapist should be started as
soon as possible. Bracing is also useful to offset the angular
acceleration of the muscle force, thereby reducing tension at the
attachment of the tendon. Use of steroid injections is usually reserved
for those who have failed conservative treatment. It is important to
correct the mechanical problem prior to a cortisone injection or the
pain will likely return. Like most injuries, the sooner treatment is
sought, the easier the recovery, and the better the outcome.
Remember that this information
is not intended as a substitute for medical advice. If you are
experiencing pain, consult your family physician or physiotherapist.
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