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Tennis Elbow / Lateral Epicondylitis (outer elbow pain) - what is it and how to fix it?

Updated: Mar 2, 2021



What is tennis elbow?

Tennis elbow, (or lateral epicondylitis) is a painful condition of the elbow often caused by overuse. As the name suggests, playing tennis or other racquet sports can cause this condition. However, several other sports and activities besides sports can also put you at risk.

Tennis elbow is inflammation or, in some cases, microtrauma of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become inflamed from repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a non-

operative approach.


Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles, where several muscles of the forearm attach. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.


Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons attach these muscles to bone.



Causes and risk factors


Overuse

Recent studies show that tennis elbow is often due to damage to the forearm muscles. The wrist extensor muscles help extend and stabilise the wrist, they are heavily involved when performing a backhand swing in tennis (therefore given the name tennis elbow). When the wrist extensors weaken from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.


Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle or repetitive extension of the wrist and hand.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.


Age

If you are aged between 30 and 50 you are more at risk of developing tennis elbow. However, it can affect people of all ages.


Unknown/Idiopathic

Sometimes tennis elbow can begin with no significant cause or change in activity, this is known as an idiopathic or unknown cause.


Symptoms

In most cases tennis elbow symptoms develop gradually over time. It begins with a mild pain in the forearm and outer elbow which worsens over weeks and months. This often begins without any significant injury.


Common symptoms include:

- Pain into the outer part of the elbow

- Pain into the forearm

- Reduced grip strength

- Tenderness to touch/press over the outer elbow


Symptoms will often worsen with forearm activities such as holding a saucepan, shaking hands or lifting a kettle. This can affect either your dominant or non-dominant hand.


Assessment/tests/imaging (what to expect)

Your doctor or physiotherapist will have to consider many factors when providing a diagnosis. To do this they will ask questions surrounding your occupation, daily activities and hobbies to determine how much stress is going through the tendons in the forearm on a regular basis.


They will ask you for a full past medical history to determine if there could be any other cause of your symptoms so it is important to tell your doctor or physiotherapist if you have any other medical conditions.


During the physical examination your doctor or physiotherapist will conduct a variety of tests to pinpoint the diagnosis. For example your physiotherapist may ask you to try and straighten your wrists or fingers against resistance. If this test is painful it suggests a positive test and it tells them that those muscles may be aggravated.


Your doctor or physiotherapist may request further imaging to rule out any other cause of your symptoms these may include:


- Xrays: these provide clear images of dense structures in the arm such as bone and can rule in or out if arthritis is a cause of your symptoms.


- Magnetic resonance imaging (MRI): An MRI scan provides images of the body soft tissue including muscles and tendons. An MRI can be ordered to determine the extent of inflammation within the tendons and rule out any other injury. If your physician thinks your symptoms could be related to your neck they may order an MRI scan of your neck to see if there are any other conditions such as arthritis or disc pathology.


- Electro myography (EMG)/Nerve conduction: your doctor or physiotherapist may order an EMG to rule out nerve compression. Many nerves travel down the arm and surface around the elbow and the symptoms of nerve compression can be similar to those of tennis elbow.


Treatment:


Approximately 80 to 95% of patients are treated non-surgically for tennis elbow with one or a combination of the following treatments:


Rest

The first step in recovery should be to rest the forearm if it is regularly exposed to repetitive loading. This means that you should stop participating in any sports, heavy work or activities that may aggravate the pain for at least two weeks.


Medications

If avoiding aggravating activities is not possible some pain relief medication may be appropriate to help manage the pain. Often anti-inflammatory based medication is effective in reducing tennis elbow pain.


Physiotherapy

Specific loading exercises prescribed by a physiotherapist will help strengthen the muscles in the forearm. This will help to increase the load capacity of the tendon so that it can better cope with the demands it is put under through your activities. They may also provide stretching based exercises to help lengthen the muscles in the forearm. Follow the link below to view a video showing some exercises that help improve tennis elbow pain.




Acupuncture/dry needling and massage:

If your pain is particularly severe manual therapies such as massage and acupuncture can be considered. This will help reduce the pain in the forearm and temporarily lengthen the muscles in the forearm allowing further benefit from the strengthening and stretching exercises given by your physiotherapist.


Follow the links below to watch a video on acupuncture for tennis elbow and self massage techniques for tennis elbow.




Brace/clasp

To help manage your pain when completing daily activities, a tennis elbow brace/clasp may help to reduce the pain. They work by providing support to the tendons in the forearm when using the muscles. The link below will take you to a page for a tennis elbow clasp we recommend to help manage your pain



Adapting equipment e.g. tennis racquet

If your tennis elbow has originated from over use from either an occupation or playing sports such as tennis adaptations can be made to your workspace or your equipment to help reduce the pain and reduce the load on the tendons of the forearm. For example, tennis racquet grip sizes can be changed to adapt the amount of stress on the tendons in your forearm when playing. Follow the link below to view tennis racquet grips that may help reduce your pain.




If you suffer from tennis elbow and would like to be assessed please contact us to book an appointment with our physiotherapist who can further guide you on treatment options and provide any manual therapies required.

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