TENNIS-ELBOW

Tennis elbow – SYMPTOMS, TREATMENT and PREVENTIONS

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Perhaps you are wondering what a Tennis Elbow is. It doesn’t sound like one of the widespread or terminal diseases, but it is something to pay attention to as no part of the human body is insignificant. While it might seem peculiar to only Tennis or racket sport players, it indeed is not. There’s a lot more.

Read on to know more about Tennis Elbow, its symptoms, causes, preventions, treatments and who is at risk?

Tennis elbow is a condition that causes pain around the outside of the elbow. It’s clinically known as Lateral Epicondylitis. It often occurs after vigorous overuse of the muscles and tendons of the forearm, near the elbow joint. It is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse (repeating the same motions again and again). This leads to pain and tenderness on the outside of the elbow.

In another source, it is also described as a type of tendinitis (swelling of the tendons) that causes pain in the elbow and arm. These tendons are bands of tough tissue that connect the muscles of your lower arm to the bone. The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to the bony prominence on the outside of your elbow. The pain may result from tiny tears in the tendon. Tennis elbow (lateral epicondylitis) is a painful condition that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

Despite its name, athletes aren’t the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters, and butchers.

The pain of tennis elbow occurs primarily where the tendons of your forearm muscles attach to a bony bump on the outside of your elbow. The 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. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

Sources: medicalnewstoday.com

SYMPTOMS

Pain is the primary reason why patients seek medical evaluation for lateral epicondylitis. The pain is located on the outside of the elbow, over the bone region known as the lateral epicondyle. This area can become tender to the touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful

The symptoms of tennis elbow include pain and tenderness in the bony knob on the outside of your elbow. This knob is where the injured tendons connect to the bone. The pain may also radiate into the upper or lower arm. Although the damage is in the elbow, you’re likely to hurt when doing things with your hands. The pain associated with tennis elbow may radiate from the outside of your elbow into your forearm and wrist.

Pain and weakness may make it difficult to:

  • Hold a tea cup
  • Shake hands or grip an object
  • Turn a doorknob
  • Lift something
  • Open a door
  • Raise your hand or straighten your wrist
  • Twist your forearm
  • Fully stretch your arm
  • Lift or bend your arm

These symptoms develop gradually.

In most cases, the pain begins very mildly and slowly worsens over weeks and months with forearm activity like holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected. You must also note that there is usually no specific injury associated with the onset of its symptoms.

There are some common signs and symptoms of tennis elbow which include:

  • Pain or burning on the outer part of your elbow
  • Weak grip strength

Sources medicalnewstoday.comAmerican Academy of Orthopaedic Surgeons

CAUSES

The elbow joint is surrounded by muscles that move your elbow, wrist, and fingers. The tendons in your elbow join the bones and muscles together and control the muscles of your forearm.

Tennis elbow is usually caused by overusing the muscles attached to your elbow and used to straighten your wrist. If the muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) on the outside of your elbow.

As the name suggests, tennis elbow is sometimes caused by playing tennis. However, it is often caused by other activities that place repeated stress on the elbow joint, such as decorating or playing the violin.

Pain that occurs on the inner side of the elbow is often known as golfer’s elbow.

Tennis elbow usually develops over time. Repetitive motions — like gripping a racket during a swing — can strain the muscles and put too much stress on the tendons. That constant tugging can eventually cause microscopic tears in the tissue.

Tennis elbow might result from:

  • Tennis
  • Racquetball
  • Weight lifting
  • Squash
  • Fencing

It can also affect people with jobs or hobbies that require repetitive arm movements or gripping such as Carpentry, Typing Painting, Raking and Knitting

Tennis elbow is an overuse and muscle strain injury. The cause is repeated contraction of the forearm muscles that you use to straighten and raise your hand and wrist. The repeated motions and stress to the tissue may result in a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow.

As the name suggests, playing tennis — especially repeated use of the backhand stroke with poor technique — is one possible cause of tennis elbow. However, many other familiar arm motions can cause tennis elbow, including:

  • Using plumbing tools
  • Painting
  • Driving screws
  • Cutting up cooking ingredients, particularly meat
  • Repetitive computer mouse use

Image credits: www.independent.ng

WHEN TO SEE A DOCTOR

If your elbow pain is caused by strenuous or repetitive activity, you should avoid the activity until your symptoms improve.

Visit your chiropractor or GP if the pain in your elbow persists, despite resting it for a few days. They will check for swelling and tenderness, and carry out some simple tests, such as asking you to extend your fingers and flex your wrist with your elbow extended.

Further tests, such as an ultrasound scan or a magnetic resonance imaging (MRI) scan will only be needed if it is thought that your pain is being caused by nerve damage.

Your doctor will consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation. Your doctor will talk to you about what activities cause symptoms and where on your arm the symptoms occur. Be sure to tell your doctor if you have ever injured your elbow. If you have a history of rheumatoid arthritis or nerve disease, tell your doctor.

During the examination, your doctor will use a variety of tests to pinpoint the diagnosis. For example, your doctor may ask you to try to straighten your wrist and fingers against resistance with your arm entirely straight to see if this causes pain. If the tests are positive, it tells your doctor that those muscles may not be healthy.

Your doctor may recommend additional tests to rule out other causes of your problem.

  • X-rays- These tests provide clear images of dense structures like bone. They may be taken to rule out arthritis of the elbow.
  • Magnetic resonance imaging (MRI) scan- If your doctor thinks your symptoms are related to a neck problem, an MRI scan may be ordered. MRIs scans show details of soft tissues and will help your doctor see if you have a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.
  • Electromyography (EMG)-Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Sources- American Academy of Orthopaedic Surgeons

tennis elbow doctor

TREATMENT AND REMEDIES

There are many treatment options for tennis elbow. In most cases, treatment usually involves a team up of clinical doctors, physiotherapists, and, in some cases, surgeons work together to provide the most effective care.

Physical therapy- Specific exercises help strengthen the muscles of the forearm. Your therapist may also perform an ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.

Brace- Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Steroid injections- Steroids, such as cortisone, are very effective anti-inflammatory medicines. Your doctor may decide to inject your damaged muscle with a steroid to relieve your symptoms

Tennis elbow is a self-limiting condition, which means it will eventually get better without treatment. However, some medications can be used to improve your symptoms and speed up your recovery.

It’s essential that you rest your injured arm and stop doing the activity that’s causing the problem.

  • Holding a cold compress, such as a bag of frozen peas wrapped in a towel, against your elbow for a few minutes several times a day can help ease the pain.
  • Taking painkillers, such as paracetamol, may help reduce mild pain caused by tennis elbow. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can also be used to help reduce inflammation.
  • Physiotherapy may be recommended in more severe and persistent cases. Massaging and manipulating the affected area may help relieve the pain and stiffness, and improve the range of movement in your arm.

Surgery may be used as a last resort to remove the damaged part of the tendon.

Most cases of tennis elbow last between six months and two years. However, in about nine out of 10 cases, a full recovery is made within a year.

To diagnose your tennis elbow, your doctor will do a thorough exam. He or she will want you to flex your arm, wrist, and elbow to see where it hurts. You may also need imaging tests, such as an X-ray or MRI (magnetic resonance imaging) to diagnose tennis elbow or rule out other problems.

In another source, the good news about treatment is that usually, tennis elbow will heal on its own. You need to give your elbow a break and do what you can to speed the healing. Types of treatment that help are:

  • Icing the elbow to reduce pain and swelling. Experts recommend doing it for 20 to 30 minutes every 3 to 4 hours for 2 to 3 days or until the pain is gone.
  • Use an elbow strap to protect the injured tendon from further strain.
  • Take a non- steroidal anti-inflammatory (NSAIDs), such as ibuprofen, naproxen, or aspirin, to help with pain and swelling. However, these drugs can cause side effects, such as bleeding and ulcers. You should only use them occasionally, unless your doctor says otherwise, since they may delay healing.
  • Performing range of motion exercises to reduce stiffness and increase flexibility. Your doctor may recommend that you do them three to five times a day.
  • Getting physical therapy to strengthen and stretch the muscles.
  • Having injections of steroids or painkillers to temporarily ease some of the swelling and pain around the joint. Studies suggest that steroid injections don’t help in the long term.

Most of the time, these treatments will do the trick. But if you have a severe case of tennis elbow that doesn’t respond to two to four months of conservative treatment, you may need surgery. In the procedure, the damaged section of the tendon usually is removed and the remaining tendon repaired. Surgery works in about 85%-90% of cases.

Surgery is only considered when the pain is disabling and has not responded to other treatments, and when symptoms have lasted six to 12 months. Surgery involves removing the diseased, degenerated tendon tissue. The operation would be performed in an outpatient setting.

SourcesAmerican Society for Surgery of the hand.

PREVENTIONS

It’s not always easy to avoid getting tennis elbow, although not putting too much stress on the muscles and tendons surrounding your elbow will help prevent the condition from getting worse.

If your tennis elbow is caused by an activity that involves placing a repeated strain on your elbow joint, such as tennis, changing your technique may alleviate the problem.

Of course, what you want to know is when you can get back to your regular activities after having tennis elbow. That depends on your case and the extent of the damage to the tendon. People heal at different rates.

Whatever you do, don’t rush your recovery. If you start pushing yourself before your tennis elbow is healed, you could make the damage worse. You are ready to return to your former level of activity when:

  • Gripping objects or bearing weight on your arm or elbow is no longer painful.
  • Your injured elbow feels as strong as your other elbow.
  • Your elbow is no longer swollen.
  • You can flex and move the elbow without any trouble.
  • Decrease the amount of playing time if already injured or feeling pain in outside part of the elbow.
  • Stay in overall good physical shape.
  • Strengthen the muscles of the forearm: (pronator quadratus, pronator teres, and supinator muscle)—the upper arm: (biceps, triceps)—and the shoulder (deltoid muscle) and upper back (trapezius). Increased muscular strength increases the stability of joints such as the elbow.
  • Like other sports, use equipment appropriate to your ability, body size, and muscular strength.
  • Avoid any repetitive lifting or pulling of heavy objects (especially over your head).

In stubborn cases, surgery may be an option. Surgical methods include:

  • Lengthening, release, debridement, or repair of the origin of the extrinsic extensor muscles of the hand at the lateral epicondyle
  • Rotation of the anconeus muscle
  • Denervation of the lateral epicondyle
  • Decompression of the posterior interosseous nerve

Surgical techniques for lateral epicondylitis can be done by open surgery, percutaneous surgery or arthroscopic surgery, with no evidence that any particular type is better or worse than another.

WHO CAN BE AFFECTED?

Tennis elbow is a common musculoskeletal condition. It’s estimated that as many as one in three people have tennis elbow at any given time. Each year in the UK, about five in every 1,000 people go to see their GP about tennis elbow. The condition usually affects adults and is more common in people who are 40-60 years of age. Men and women are equally affected.

Factors that may increase your risk of tennis elbow include:

  • While tennis elbow affects people of all ages, it’s most common in adults between the ages of 30 and 50.
  • People who have jobs that involve repetitive motions of the wrist and arm are more likely to develop tennis elbow. Examples include plumbers, painters, carpenters, butchers, and cooks.
  • Certain sports. Participating in racket sports increases your risk of tennis elbow, especially if you employ poor stroke technique.
  • Tennis players, about 39.7% have reported current or previous problems with their elbow. Less than one quarter (24%) of these athletes under the age of 50 said that the tennis elbow symptoms were “severe” and “disabling,” while 42% were over the age of 50. More women (36%) than men (24%) considered their symptoms severe and disabling. Tennis elbow is more prevalent in individuals over 40, where there is about a four-fold increase among men and two-fold increase among women. Tennis elbow equally affects both sexes and, although men have a marginally higher overall prevalence rate as compared to women, this is not consistent within each age group, nor is it a statistically significant difference.
  • Playing time is a substantial factor in tennis elbow occurrence, with increased playing time being greater for respondents under 40. Individuals over 40 who played over two hours doubled their chance of injury. Those under 40 increased it 3.5 fold compared to those who played less than two hours per day.

SUMMARY

With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area. This can lead to pain associated with activities in which this muscle is active, such as lifting, gripping or grasping. Sports such as tennis are commonly associated with this, but the problem can occur with many different activities.

Athletes are not the only people who are affected with tennis elbow. Many people who participate in jobs or recreational activities that require repetitive and vigorous use of the forearm muscle are at risks of having the condition.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, 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.

In a nutshell, Tennis Elbow doesn’t affect only racket sports players. Just as you have read, anyone can be susceptible to its pain. You might want to get more particular and conscious about your body wellness, so as not to get stuck with tennis elbow. Stay healthy!

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