Tennis Elbow

What is tennis elbow?

Tennis elbow, also known as lateral epicondylitis, is a painful condition that develops when too much strain is placed upon the tendons within the elbow. This can be caused by repetitive movements in the arm and wrist.

Tennis elbow can affect anyone, but people who are more likely to be affected include thise whose jobs involved repetitive movements, such as plumbers, painters, carpenters and butchers.

The pain usually starts on the outside of the elbow where the tendons of the forearm muscles are joined to a bony lump on the outside of the elbow. The pain can also affect the rest of the forearm and the wrist.

Tennis elbow can often be managed with conservative treatment such as rest and over the counter medication, but in cases where this does not provide relief, surgery may be recommended.

Common signs and symptoms of tennis elbow

Pain in the bony bump outside your elbow is the most common symptom. Usually, it evolves gradually over time and it may radiate from the elbow to the rest of your forearm. It is likely to be worsened when:

  • Shaking and stretching hands
  • Turning doorknobs
  • Holding small objects

Common causes of tennis elbow

Tennis elbow appears as a consequence of overuse and repeated activity of your forearm, particularly activities that involved the use of a backhand stroke, as in tennis. These repeated motions can cause the muscles to develop tiny tears in the tendon that runs from your forearm to the bony lump on the elbow.

Despite its name, it affects more people than just athletes. Other professions and activities that can cause tennis elbow to develop include:

  • Plumbing
  • Painting
  • Cooking
  • Butchery
  • Carpentry
  • Driving
  • Computer use

There are generally three main risk factors which can increase a person’s chance of developing tennis elbow:

  • Age – adults between the ages of 30 and 50 are more likely to get tennis elbow than younger people
  • Occupation – people who have jobs that involve repetitive arm and wrist movements can be prone to tennis elbow
  • Racket sports – as with the name, those who play racket sports such as tennis may be at risk of tennis elbow, especially if they play with poor formju

 

Diagnosing tennis elbow

Your doctor will begin by performing a physical examination. This will involve apply pressure to your elbow and forearm to check for tenderness and asking you to move your wrist and arm. Often, this examination along with reviewing your medical history will be enough to diagnose the condition. However, if your doctor suspects that something else may be causing your symptoms, they may suggest imaging tests such as x-rays or other types of scans.

Treating tennis elbow

Tennis elbow usually improves on its own. In most cases, self-care techniques can help to relieve symptoms.

Self-care

  • Rest –stop any activities or movements that are causing pain
  • Over-the-counter pain relief – Ibuprofen (Brufen) or Paracetamol (Panadol) ca help to reduce pain
  • Ice – apply ice to the area for 15 minutes three to four times a day
  • Technique – ensure that during activities and sports, you are using the proper techniques and avoiding repetitive motions where possible

Non-Surgical Treatments

Most of the time, conservative treatment will yield successful results. But if it does not appear to be working for you, some other non-surgical options include:

  • Physiotherapy – a course of physiotherapy may be helpful in allowing you to identify the repetitive movements or strain that is causing your symptoms. Your physiotherapist can assess your movements and guide you on how to adapt. They will also show you certain exercise which can help to improve the strength and muscle tone in your arm. Your physiotherapist may even recommend that you wear a forearm strap to reduce the strain on your arm and elbow.
  • Injections directly into the elbow – the injection may contain platelet-rich plasma, Botox or some form of irritant (prolotherapy). Dry needling, where the needle is used to pierce the tendon in several places, may also be helpful.
  • Ultrasonic tenotomy (TENEX procedure) – using an ultrasound for guidance, your doctor will insert a needle into the damaged area of the tendon. The ultrasonic energy vibrates at a speed high enough to cause the damaged tissue to liquefy. Your doctor can then suction this out.

Surgery

If after 6 to 12 months of previous treatments, no evidence of improvement is shown, your doctor may recommend a surgical procedure to repair the small tendons that are damaged, and/or remove the damaged tissue in your elbow’s tendons and muscles.  This could be done via two surgical methods, open surgery or arthroscopic (keyhole) surgery.

Recovery

After surgery, resting for about 1-2 weeks is required before starting the rehabilitative physiotherapy to restore your elbow’s flexibility and motion.

The complete recovery period will be different for each person. Generally, it takes about four to six months of physiotherapy to recover the entire function of your forearm and return to your daily activities.

Even though surgery is successful in more than 90% of patients, acquiring the condition again is possible. Particularly if physiotherapy and the recovery time is not adhered to.

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