-Cyprus Orthopaedics

Tennis Elbow

Tennis elbow is a painful condition of the elbow, which commonly affects active individuals over the age of 30 years. The condition, which is also known as “lateral epicondylitis”, usually commences with insidious onset of pain on the outer aspect of the elbow. Occasionally the pain may follow an injury to the elbow. The condition is not specific to tennis players nor athletes. It often occurs in individuals in manual occupations or those who perform repetitive lifting or carrying tasks.
Elbow Conditions-Cyprus Orthopaedics

Tennis Elbow

Tennis elbow is a common condition that affects many individuals, not just those who play tennis. Despite its name, this condition can occur in anyone who repeatedly uses their forearm muscles, causing pain and discomfort.

What is Tennis Elbow?

Tennis elbow, medically known as lateral epicondylitis, is a condition characterized by pain and inflammation in the tendons that connect the muscles of the forearm to the elbow joint. These tendons become strained and damaged due to repetitive and excessive use of the forearm muscles, leading to the development of tennis elbow. Despite its name, tennis elbow is not limited to tennis players and can affect individuals involved in various activities that involve repetitive forearm movements, such as painting, gardening, or playing musical instruments.

Causes of Tennis Elbow

Tennis elbow is primarily caused by repetitive stress and overuse of the forearm muscles. This strain can occur from activities that involve gripping, twisting, or lifting objects, such as using a computer mouse, carrying heavy bags, or playing sports like tennis or golf. The repeated movements and stress on the tendons can lead to micro-tears and degeneration, resulting in pain and inflammation.

Other contributing factors to tennis elbow include poor technique or form during physical activities, inadequate warm-up or cool-down routines, and using equipment that is not properly fitted or suited to the individual’s needs. Additionally, certain occupations that require repetitive forearm movements, such as plumbing or carpentry, can also increase the risk of developing tennis elbow.

Symptoms of Tennis Elbow

The most common symptom of tennis elbow is pain and tenderness on the outside of the elbow. This pain can radiate down the forearm and may worsen with activities that involve gripping, lifting, or twisting motions. Individuals with tennis elbow may also experience weakness in their grip and difficulty in performing everyday tasks, such as opening jars or shaking hands.

In some cases, swelling and inflammation may be present around the affected area. The pain and discomfort associated with tennis elbow can vary in intensity, ranging from mild to severe, and may worsen over time if left untreated. It is important to seek medical attention if you experience persistent pain or if your symptoms significantly impact your daily activities.

Various factors can elevate the likelihood of experiencing tennis elbow:

Age: While tennis elbow can impact individuals of all age groups, it predominantly affects adults ranging from 30 to 60 years old.

Occupational Activities: Occupations requiring repetitive movements of the wrist and arm, such as plumbing, painting, carpentry, butchery, and cooking, heighten the susceptibility to developing tennis elbow.

Specific Sports: Engaging in racket sports amplifies the risk of tennis elbow. Poor technique or inadequate equipment further exacerbates this risk. Additionally, playing these sports for more than two hours a day can also elevate the likelihood of developing tennis elbow.

Diagnosing Tennis Elbow

To diagnose tennis elbow, a healthcare professional will conduct a thorough physical examination and evaluate your medical history. They will assess your range of motion, strength, and stability of the affected arm and may perform specific tests to determine the source of your pain.

In some cases, imaging tests such as X-rays or an MRI may be ordered to rule out other conditions that may present similar symptoms. These tests can help to identify any bone abnormalities, fractures, or soft tissue damage that may be contributing to your symptoms.

Treatment Options for Tennis Elbow

The treatment for tennis elbow typically involves a combination of conservative measures and, in severe cases, surgical intervention. The initial approach focuses on reducing pain, inflammation, and promoting healing of the affected tendons.

Non-surgical treatment options include rest and the use of nonsteroidal anti-inflammatory drugs (NSAIDs) to alleviate pain and reduce inflammation. Physical therapy is often recommended to strengthen the muscles of the forearm and improve flexibility. Your healthcare provider may also suggest wearing a brace or splint to provide support and relieve strain on the affected area.

In cases where conservative measures fail to provide relief or if the condition is severe, surgical intervention may be considered. This typically involves removing damaged tissue and repairing or reattaching the affected tendons. Surgery is usually followed by a period of rehabilitation to restore strength and function to the forearm.

Preventing Tennis Elbow

Prevention is key when it comes to tennis elbow. Some measures you can take to reduce your risk of developing this condition include:

  • Proper technique: Ensure that you are using the correct form and technique when engaging in activities that involve repetitive forearm movements. This can help distribute the load evenly and reduce strain on the tendons.
  • Warm-up and cool-down: Always remember to warm up your muscles before engaging in any physical activity and cool down afterward. This can help prepare your muscles for the activity and prevent injuries.
  • Strengthening exercises: Regularly perform exercises that target the muscles of the forearm to improve their strength and flexibility. This can help reduce the risk of strain and injury.
  • Use appropriate equipment: Use equipment that is properly fitted and suited to your needs. For example, when playing tennis, ensure that your racket grip size is appropriate for your hand size to minimize strain on the forearm muscles.

The condition is believed to result from overuse. The tendons of the elbow suffer wear and tear over time. This results in degeneration of the tendons and occasionally there may be microscopic or partial tears in the tendon. Some natural healing may take place but often there is a process of repeated breakdown and incomplete healing which results in pain.

A diagnosis of Tennis elbow is made from the history of pain localised to the outer aspect of the elbow and occasionally down the forearm. Pain is usually intermittent and often experienced with activities. Pain may be associated with weakness of grip. Examination shows localised tenderness on the outer aspect of the elbow and pain with certain provocative manoeuvres such as extending the wrist against resistance. An X-ray may sometimes show bone spurs or calcium deposits. An ultrasound scan or MRI may be performed to examine the state of the tendons. If associated nerve pain is suspected, electromyography (EMG) or nerve conduction tests may be requested.

In the early phase, pain may be controlled with activity modification and the use of pain relieving or anti-inflammatory medication. In most individuals, Tennis elbow is a self-limiting condition that often resolves slowly over a variable period of time ranging from 6-18 months.

Supervised physiotherapy: You may be advised to see a physiotherapist to start a regime of specific treatment that includes deep friction, stretching of the affected tendons and eccentric strengthening exercises. There is good evidence to suggest that supervised physiotherapy improves symptoms.

Instructions on a therapeutic exercise program for tennis elbow can be downloaded from the Orthoinfo website.

The British Elbow and Shoulder Society (BESS) website has an Instructional video on Exercises for Tennis elbow.

Clasp: Wearing an epicondylitis clasp on the forearm will often help ease symptoms particularly if worn during activities. It may also act as a reminder to modify activities.

Shockwave therapy: This is a non-invasive treatment, which aims to stimulate the body’s natural healing process for this condition. At least three treatments are required at weekly intervals.

Steroid injectionA steroid injection placed accurately into the tendon origin will often provide good short to medium term pain relief allowing progress to be made with physiotherapy. The injection will not cure the condition. It is not advisable to have multiple injections.

Platelet-rich-plasma (PRP) injection: A small amount of venous blood is withdrawn from the patient and spun in a special centrifuge for 5 min. This yields a sample of Plasma rich in platelets, which are the blood cells that play an important role in healing. A small volume (approximately 2ml) is injected into the origin of the tendon using a multiple puncture technique. The procedure is painful and shows some benefit compared with steroid injections over the long term.

Surgery: In a small minority of patients, in whom symptoms have persisted despite adequate nonoperative treatment, it may be appropriate to undertake surgical treatment. Surgery may be performed arthroscopically (“key-hole” surgery) or open and the most appropriate technique for your condition will be discussed with you. Arthroscopic surgery may be preferred to open surgery as it leaves smaller scars, causes less tissue damage, allows the inside of the joint to be examined and is associated with less pain, an easier recovery and better long term outcome. The origin of the affected extensor tendon is released from the bone and the bone may be drilled, abraded or treated with microfracture to promote healing. Following surgery symptoms will usually settle over a period of time. For further information on surgical treatment, please refer to the procedures section.

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