Tennis Elbow

Description

Tennis elbow is frequently known as lateral epicondylealgia among health professionals. It is a repetitive strain injury typically associated with workers who undergo a lot of manual handling such as industry workers, cleaners or tennis players. Tennis elbow developed its name because it is commonly seen in tennis payers as the back hand stroke places large eccentric (a lengthening muscle contraction) forces on the extensor tendons (the muscles and tendons that run up the back of your forearm).

As with all tendinopathies, they develop over time through repetitive work. The pathology behind the disorder is from the subject not allowing sufficient time to recover following heavy work, resulting in insufficient healing of the tendon, causing gradual wear and tear. This gradual wear and tear eventually turns in to substantial degeneration associated with pain weakness and associated pathologies.

Once a tendinopathy such as tennis elbow has developed it can take months to heal. They can remain unresolved for years if they are allowed to develop into a chronic condition and do not receive the appropriate treatments. The reason for this is that tendons have a poor blood supply resulting a slow cell turnover. As blood brings all the nutrients to the tissues to help them remodel, any reduction in this (as comparing tendons to muscles which have a rich blood supply) will result in slower healing times. For these reasons it is essential you catch a disorder such as tennis elbow early and give it appropriate treatments before it becomes a chronic condition.

Associated pathologies of tennis elbow include:

  • Calcification in the soft tissue around the lateral elbow in 25% of cases.
  • Carpal tunnel in around 10% of cases of tennis elbow.
  • Radial tunnel syndrome in 10% of cases.

Symptoms

Signs and symptoms of tennis elbow include:

  • Pain on gripping, or lifting objects.
  • Tightness/discomfort on stretch of your forearm muscles.
  • Discomfort with resisted wrist movements.
  • Discomfort over your elbow, can be in the muscle or on the bone itself.
  • Numbness through your forearm (entrapped radial nerve).

Treatment

Physiotherapy treatments of tennis elbow include:

  • Soft tissue mobilisations (specific massage techniques).
  • Mobilisations to restore full joint movements.
  • Stretching.
  • Bracing or taping to take pressure of the extensor tendon complex attachment point.
  • The correct strengthening exercises.

Currently research shows that the most benficial treatment is the use of eccentric exercises to stimulate the remodelling of the tendons. These exercises cause the breakdown of the tendons allowing for the remodelling process to take place. As you can imagine careful management is required to ensure the right amount of eccentric exercises are performed otherwise you could make your condition substantially worse by increasing the amount of degeneration of your tendons.

The use of cortisone injections has been decreasing, they show good short term pain relief for up to 6 weeks but show no improvements in the long term for tennis elbow. If you and your doctor decided to procede with a cortisone injection it is important that you consult your physiotherapist to commence a strengthening programme. Use this 6 week window to strengthen your extensor tendons so that when the effects of the cortisone wears off the integrity of your tendons will be improved and therefore they will cause you less pain. If you fail to strengthen your elbow following a cortisone, your condition will be the same or even worse once the cortisone stops working. The wrong exercises may also damage your tendons as they are still very vulnerable at this stage.