Tennis Elbow (Lateral Epicondylitis): Causes, Symptoms & How We Can Help You
Tennis elbow or otherwise known as lateral epicondylitis is the most common condition that affects the elbow region. Characteristically with tennis elbow the tendons of the lateral elbow joint become inflammed which leads to pain and discomfort involving the elbow and forearm. The forearm muscles and tendons typically become damaged from repetition or prolonged overuse. The elbow joint consists of three bones: your upper arm bone (humerus) and the two forearm bones (radius and ulna). Various soft tissue structures including muscles, ligaments and tendons attach around the elbow joint to allow arm movement and stability. In regards to tennis elbow, the muscles responsible for extension attach to the lateral epicondyle. The major muscle involved in tennis elbow is referred to as the extensor carpi radialis brevis (ECRB).
CAUSES OF TENNIS ELBOW (LATERAL EPICONDYLITIS)
Tennis Elbow is most commonly caused by overuse activities associated with repetitive sports actions causing the muscles that control the wrist and forearm to become overloaded. This continual stress causes micro-tears and an inflammatory reaction to occur in the lateral elbow muscles and tendons. The problem typically presents in individuals between the ages of 20 to 40 years, with both males and females equally affected. Please see below for a brief list of common actions which may contribute to the development of lateral epicondylitis:
- Tennis or other associated racquet sports
- Prolonged or extension use of tradesman tools such as hammers
- Playing musical instruments
- Gym activities and exercises
- Computer use
- Unaccustomed work involving the wrist and hands
COMMON TENNIS ELBOW SYMPTOMS
The signs and symptoms of tennis elbow are quite distinctive and therefore practitioners should have no difficulty arriving at an appropriate diagnosis of lateral epicondylitis. Typical symptoms which individuals may experience include:
- A sharp and localised pain on the outside area of the elbow, pain may arise whilst performing a grip or wrist activity
- Tenderness of the lateral forearm area that may extend towards the hand and fingers
- Difficulty griping items and weakness of the forearm
HOW IS TENNIS ELBOW DIAGNOSED?
Tennis elbow is generally detected as a tender spot at the outside area of the elbow in conjunction with various history findings that your practitioner will discover during discussion. It is important for your Chiropractor or health care professional to rule out other possible differential diagnoses before commencing treatment. A musculoskeletal therapist should perform the following measures in order to arrive at an appropriate diagnosis:
- Review of medical history as well as various injury specifics such as mechanism of injury, location of pain, quality of pain, aggravating and relieving factors
- Physical examination including palpation, muscle testing, range of motion assessment as well as various injury specific orthopaedic and neurological tests if required
Referral for imaging may be clinically indicated to assist your practitioner in formulating an appropriate diagnosis and therefore management plan. Such images may include Ultrasound, MRI or CT.
TREATMENT OPTIONS AVAILABLE FOR TENNIS ELBOW
Tennis elbow can sometimes be a difficult condition to manage given how frequently we use our hands and arms during activities of daily living. While this is the case there are various steps which you can implement to assist in prompt recovery.
- Avoiding activities that aggravate the problem, limiting the weight load you carry on your hands.
- Resting the injured area to assist with reducing inflammation, pain and improving general function
- Other anti-inflammatory measures such as ice application to the injured area, anti-inflammatory medication as well as dietary or nutritional changes
Chiropractic & Physiotherapy
Treatment will focus on reducing the immediate symptoms and improving the functionality of the elbow. However, traditional management is aimed at reducing inflammation, eliminating pain and enhancing general function and ability to complete activities of daily living. Treatment may include techniques such as joint mobilisation, stretching, massage, physiological therapeutics (ice/heat/ultrasound/laser/shockwave therapy) and specific exercise advice. Associated treatment devices such as elbow braces may also be recommended.
Your doctor may prescribe medication to reduce inflammation in the tendons. Corticosteroids, also known simply as “steroids,” are often used because they work quickly to decrease the inflammation and therefore associated discomfort and pain. Steroids may be injected directly into the area itself.
While rare, surgical intervention may be warranted if other treatment methods have been exhausted and deemed unhelpful. It is recommended that you discuss various surgical intervention options with your general practitioner or treating therapist.
WHAT DOES THE RESEARCH TELL US?
- Low level Laser therapy applied directly to the lateral elbow tendon insertion points appears to offer clinical significant short term pain improvements for individuals suffering from Lateral Epicondylitis. Bjordal, J. (2008). A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskeletal Disorders, 9(75)
- Conservative management such as Physiotherapy that combines elbow joint manipulation and or mobilisation with exercise has a superior benefit for sufferers of Tennis Elbow (Lateral Epicondylitis) then postponing management or using Cortisone injections to manage dysfunction. Bisset, L. (2006). Mobilisation with movement and exercise, corticosteroid injection or wait and see for tennis elbow: randomised trial. BMJ.