TENNIS ELBOW

Tennis Elbow: Tennis elbow, or lateral epicondylitis, is a painful inflammation of the elbow joint caused by repetitive stress (overuse). The pain is located on the outside (lateral side) of the elbow but may radiate down the back of your forearm. You’ll likely feel the pain when you straighten or fully extend your arm.

 

 

What are the symptoms of tennis elbow?

 

You may experience some of the following symptoms if you have tennis elbow:

 

·      elbow pain that is mild at first but gradually gets worse

·      pain extending from the outside of the elbow down to the forearm and wrist

·      a weak grip

·      increased pain when shaking hands or squeezing an object

·      pain when lifting something, using tools, or opening jars

 

How is tennis elbow diagnosed?

 

Tennis elbow is usually diagnosed during a physical exam. Your doctor will ask you about your job, whether you play any sports, and how your symptoms developed. They will then perform some simple tests to help make a diagnosis. Your doctor may apply some pressure to the spot where the tendon attaches to the bone to check for pain. When the elbow is straight and the wrist is flexed (bent toward the palm side), you’ll feel pain along the outer side of the elbow as you extend (straighten) the wrist.

 

Your doctor may also order imaging tests, such as an X-ray or MRI scan, to rule out other disorders that can cause arm pain. These include arthritis of the elbow. These tests are not usually necessary to make a diagnosis.

 

 

How is tennis elbow treated?

 

Nonsurgical interventions

 

About 80 to 95 percent of tennis elbow cases can be successfully treated without surgery. Your doctor will first prescribe one or more of the following treatments:

 

Rest: The first step in your recovery is to rest your arm for several weeks. Your doctor may give you a brace to help immobilize the affected muscles.

Ice: Ice packs placed over the elbow can help reduce inflammation and relieve pain.

Nonsteroidal anti-inflammatory medicines: Over-the-counter medications, such as aspirin and ibuprofen, can help reduce pain and swelling.

Physical therapy: A physical therapist will use various exercises to strengthen the muscles of your forearm and promote healing. These may include arm exercises, ice massage, and muscle-stimulating techniques.

Ultrasound therapy: In ultrasound therapy, an ultrasound probe is placed over the most painful area on your arm. The probe emits high-frequency sound waves into the tissues for a set period of time. This type of treatment can help reduce inflammation and speed up recovery.

Steroid injections: Your doctor may decide to inject a corticosteroid medication directly into the affected muscle or where the tendon attaches to the bone at the elbow. This can help reduce inflammation.

Shock wave therapy: This is an experimental treatment that delivers sound waves to the elbow to promote the body’s own healing process. Your doctor may or may not offer this therapy.

Platelet-rich plasma injection: This is a treatment possibility that seems quite promising and is being used by some physicians. However, it is usually not covered by insurance companies presently.

 

Surgery

Surgery may be needed if symptoms don’t improve after a year of treatment. You and your doctor can determine whether surgery is necessary to improve your condition.

 

Surgery is either performed through a small scope that’s inserted into the elbow (arthroscopically) or through a larger incision made directly over the elbow (open surgery). Both methods are used to remove any dead tissue and to reattach healthy muscle onto the bone.

 

After surgery, your arm may be immobilized with a splint. This is done to help restore muscle strength and flexibility.

 

Surgery successfully treats tennis elbow in 80 to 90 percent of cases. However, it’s common to experience some loss of muscle strength.

 

EXERCISES

Fist clench

Poor grip strength is a common symptom of tennis elbow. Improving grip strength by building the muscles of the forearm can help improve the ability to perform daily activities.

Equipment needed: table and towel

Muscles worked: long flexor tendons of the fingers and thumb

Sit at a table with your forearm resting on the table.

1. Hold a rolled-up towel or small ball in your hand.
2. Squeeze the towel in your hand and hold for 10 seconds.
3. Release and repeat 10 times. Switch and do the other arm.

Supination with a dumbbell

The supinator muscle is a large muscle of the forearm that attaches into the elbow. It’s responsible for turning the palm upward and is often involved in movements that can cause tennis elbow.

Equipment needed: table and a 2-pound dumbbell

Muscles worked: supinator muscle

Sit in a chair holding a 2-pound dumbbell vertically in your hand with your elbow resting on your knee.

1. Let the weight of the dumbbell help rotate the arm outward, turning the palm up.
2. Rotate the hand back the other direction until your palm is facing downward.
3. Repeat 20 times on each side.
4. Try to isolate the movement to your lower arm, keeping your upper arm and elbow still.

Wrist extension

The wrist extensors are a group of muscles that are responsible for bending the wrist, like during the hand signal for stop. These small muscles that connect into the elbow are often subject to overuse, especially during racquet sports.

Equipment needed: table and a 2-pound dumbbell

Muscles worked: wrist extensors

Sit in a chair holding a 2-pound dumbbell in your hand with your palm facing down, resting your elbow comfortably on your knee.

1. Keeping your palm facing down, extend your wrist by curling it towards your body. If this is too challenging, do the movement with no weight.
2. Return to starting position and repeat 10 times on each side.
3. Try to isolate the movement to the wrist, keeping the rest of the arm still.

Wrist flexion

The wrist flexors are a group of muscles that work opposite the wrist extensors. These small muscles that connect into the elbow are also subject to overuse, leading to pain and inflammation.

Equipment needed: table and a 2-pound dumbbell

Muscles worked: wrist flexors

Sit in a chair holding a 2-pound dumbbell in your hand with your palm facing up and elbow resting comfortably on your knee.

1. Keeping your palm facing up, flex your wrist by curling it towards your body.
2. Return to starting position and repeat 10 times on each side.
3. Try to isolate the movement to the wrist, keeping the rest of the arm still.

Towel twist

Equipment needed: hand towel

Muscles worked: wrist extensors, wrist flexors

Sit in a chair holding a towel with both hands, shoulders relaxed.

1. Twist the towel with both hands in opposite directions as if you are wringing out water.
2. Repeat 10 times then repeat another 10 times in the other direction.

Warnings

Always consult a doctor before starting an exercise program. It’s important to have a full evaluation to rule out serious injuries such as a muscle or tendon tear.

Don’t begin activities until inflammation has subsided, as it may aggravate the condition. If pain returns after activity, rest and ice your elbow and forearm and consult a physical or occupational therapist to ensure you are doing the exercises correctly.

Often, changing the way you perform a daily activity can help decrease symptoms and your therapist can help you determine what movements may be causing pain.