Tennis Elbow

 Overview

Tennis elbow, or lateral epicondylitis, is a condition characterized by pain and tenderness on the outer part of the elbow. It results from overuse or repetitive strain on the forearm muscles and tendons that attach to the lateral epicondyle of the humerus (the bony prominence on the outer elbow). Despite its name, it is not limited to tennis players and can affect anyone engaged in repetitive arm movements.

Symptoms

1. Pain:

   • Located on the outside of the elbow, often radiating to the forearm and wrist.

   • Worsens with gripping, lifting, or twisting movements (e.g., turning a doorknob).

2. Weak Grip Strength: Difficulty holding objects or shaking hands.

3. Tenderness: Soreness over the lateral epicondyle.

4. Stiffness: Especially in the morning or after periods of inactivity.

5. Pain with Specific Activities:

   • Lifting light objects (e.g., a coffee cup).

   • Using tools or typing.

Causes

Tennis elbow is caused by overuse or repetitive stress on the extensor tendons of the forearm, especially the extensor carpi radialis brevis (ECRB) muscle.

Common Causes:

1. Repetitive Arm Movements:

   • Tennis (especially improper backhand technique).

   • Painting, plumbing, or carpentry.

   • Typing or excessive mouse use.

2. Direct Trauma:

   • Sudden strain or injury to the tendons.

3. Poor Equipment or Technique:

   • Using a heavy racket or gripping it too tightly in tennis.

Risk Factors

1. Age: Most common in individuals aged 30–50.

2. Occupations: Jobs involving repetitive arm movements (e.g., construction, manual labour).

3. Sports: Particularly racquet sports or activities with repetitive wrist and elbow motions.

Diagnosis

1. Medical History: Discuss symptoms, activity patterns, and potential causes.

2. Physical Examination:

   • Palpation: Tenderness over the lateral epicondyle.

   • Resisted Wrist Extension Test: Pain when extending the wrist against resistance.

   • Mill’s Test: Pain with passive wrist flexion and elbow extension.

3. Imaging (if needed):

   • X-rays: Rule out arthritis or fractures.

   • MRI or Ultrasound: Assess tendon damage in severe cases.

Treatment Options

Non-Surgical Management:

Most cases improve with conservative treatments.

1. Rest and Activity Modification:

   • Avoid activities that exacerbate symptoms.

   • Take breaks to reduce repetitive strain.

2. Pain Management:

   • Ice Packs: Apply for 15–20 minutes every few hours to reduce inflammation.

   • NSAIDs: Over-the-counter medications like ibuprofen for pain relief.

3. Physical Therapy:

   • Physical treatment & intervention

   • Stretching and strengthening exercises for the forearm muscles.

   • Focus on eccentric strengthening (slow, controlled lowering movements).

4. Bracing:

   • Use a counterforce brace to reduce strain on the tendons.

5. Corticosteroid Injections:

   • May provide short-term pain relief but could delay tendon healing.

6. Shockwave Therapy:

   • Non-invasive treatment using sound waves to stimulate tendon healing.

7. Platelet-Rich Plasma (PRP) Injections:

   • Uses the patient’s blood to promote tendon repair.

Surgical Treatment

Reserved for severe or chronic cases that don’t respond to conservative treatments after 6–12 months.

• Tendon Release Surgery: Damaged portions of the tendon are removed or repaired.

Recovery Process

• Non-Surgical Recovery: Most individuals recover within 6–12 months with proper management.

• Post-Surgical Recovery: Rehabilitation can take 3–6 months to restore strength and range of motion.

Exercises for Tennis Elbow

Stretching

1. Wrist Flexor Stretch:

   • Extend your affected arm with the palm facing up.

   • Use your other hand to gently pull the fingers down and back.

   • Hold for 20–30 seconds; repeat 3 times.

2. Wrist Extensor Stretch:

   • Extend your affected arm with the palm facing down.

   • Use your other hand to pull the fingers toward your body.

   • Hold for 20–30 seconds; repeat 3 times.

Strengthening

1. Eccentric Wrist Extension:

   • Hold a light dumbbell (or can) with your palm facing down.

   • Slowly lower the weight as your wrist bends downward.

   • Use your other hand to return to the starting position.

   • Repeat for 10–15 repetitions, 2–3 sets.

2. Ball Squeeze Exercise:

   • Hold a soft ball or rolled towel.

   • Squeeze it firmly and hold for 5 seconds.

   • Repeat 10–15 times.

3. Forearm Supination with Resistance Band:

   • Hold a resistance band with your palm up.

   • Rotate your forearm outward against the band’s resistance.

   • Perform 2–3 sets of 10 repetitions.

Potential Complications

1. Chronic Pain: Persistent discomfort if untreated.

2. Reduced Grip Strength: Difficulty with daily activities.

3. Tendon Rupture: Rare, but possible with severe or untreated cases.

Prevention

1. Proper Technique:

   • Use the correct form in sports and other activities.

2. Ergonomic Adjustments:

   • Adjust workstations, tools, and equipment to reduce strain.

3. Strength Training:

   • Strengthen forearm and wrist muscles to prevent overuse injuries.

4. Stretch Regularly:

   • Perform wrist and forearm stretches before and after activities.

Prognosis

• Most individuals recover fully with proper treatment.

• Consistent therapy and prevention strategies can minimize recurrence.