This condition is also known as Lateral epicondylitis and is characterized by pain on the outside of the elbow joint. The inflammed tendon of the wrist extensors [the muscles that lift the wrist upwards] is usually the source of the pain.It was considered common in tennis players causing them pain on back hand shots. It causes pain on gripping, opening jars and bottles and lifting. There may be heat and swelling associated with it. X rays can out rule oesteo arthritis in the elbow joint but it should be noted that O.A. in the elbow is uncommon.
Repetitive trauma often from sporting activities but also from D.I.Y., gardening and assembly line work. Faulty sporting technique, poor workplace ergonomics, poor equipment [e.g. wrong size grip on tennis raquet or using a rusty shears to cut a hedge] and poor bio-mechanics can cause the problem.If insufficient rest is taken from the aggravating activities the problem can become chronic and tendon can degenerate causing weakness in the affected muscle groups and chronic pain.
Bio mechanical analysis of the upper limb and its movemnet patterns to determine causative factors will be undertaken on the first assessment. It is vital to determine the cause so that recurrence can be avoided. Sports or workplace equipment may need to be reviewed.Video analysis of sporting technique may be necessary. It should also be noted that pain in this area can be referred by the neck and shoulder and that treatment may need to be directed at these areas also.
Physiotherapy for tennis elbow
In the acute phase R.I.C.E will be advised. The arm will need to rest.It is particularly important to rest from aggravating activities such as tennis, badminton, golf and painting/DIY. During the first 48 hours ice every few hours for 10 minutes at a time in helpful. Compressingthe area with a tubular bandage can help minimize swelling. Elevation would be helpful to avoid/minimize swelling.Physiotherapy treatment may involve mobilizing stiff joints, massage, dry needling, and individually tailored exercises. Electrotherapy such as ultrasound and interferential. This will all help optimise healing and decrease pain.Sometimes taping or braces are used to off load sensitive structures. Rest is important in the acute phase. As the condition settles graded eccentric strengthening exercises will be prescribed.
Most cases of tennis elbow will respond well to physiotherapy. A small number of severe cases will not and they may require surgical intervention. Any of our patients falling into this category will be referred on to an orthopeadic surgeon who specializes in upper limb [arm] disorders.
In the past many tennis elbows were treated with cortioco steroid injections. In the short term this was often successful. Recent clinical studies suggest that long term benefits are poor . For this reason most clinicians advocate trying conservative care first before getting the area injected.
There are now also injection treatments available that uses cells in the patients own blood to improve healing rates. The procedure involves the doctor taking blood from the patient which then is treated in the lab to extract the cells needed for injection. It is a new treatment and professionals differ on their views in its efficacy.