Tennis Elbow

WHAT IS IT?

• Inflammation of the forearm and wrist muscles / tendons that attach to the bone on the outside of the elbow ~ the lateral epicondyle

HOW DO THE MUSCLES AND TENDONS WORK?

• extend the wrist and fingers, as well as contract when making a fist, lifting, or carrying things
• turn forearm up ~ ‘palm up’ position termed supination

WHAT HURTS?

• tender lateral epicondyle ~ bony point on outside of elbow
• may have radiating pain into the forearm
• pain on grasping, squeezing, or lifting objects
• pain when bending and straightening elbow, and when rotating forearm
• pain with repetitive use at home or work for example painting, hammering, cleaning, computer work, writing.
• pain is NOT limited to tennis players or athletes!

WHAT SHOWS UP ON X-RAY?

• usually nothing
• calcium deposit in advanced stage only occasionally
• arthritic changes at the lateral elbow joint where the radius meets humerus - not often

WHAT CAUSES IT?

• overuse, sport or daily activity related
• weak forearm muscles or imbalance between flexor and extensor muscle groups
• inadequate flexibility or endurance
• improper stroke technique - use of arm instead of body
• novice player more at risk
• equipment error - heavier, stiffer racquet, grip size, too tight stringing
• direct trauma
• cervical spine nerve pinching
• adverse neural tension ~ lack of mobility of nerve tissues
• residual dysfunction of other upper extremity joints

WHY DOES IT HURT?

• muscle and tendon overexertion causes pulling of tendon from bone
• microtearing of tendon, inflammation, scar tissue formation and shortening of tendon
• becomes easier and easier to tear or re-injure unless treated properly
• poor nutrition from the nerve to the lateral epicondyle also causes tendon degeneration and pain

WHAT DO I DO?

• rest from painful activities and apply ice or heat depending on situation and condition
• analyze cause, address biomechanical causes with appropriate stretching of shortened or stiff structures and strengthening of relatively weak areas as outlined by your physiotherapist
• correct equipment and technique errors
• use of a brace to minimize stress on the injured area
• use of ice in acute, more painful conditions
• deep transverse friction massage breaks down scar tissue, relieves pain, and promotes healing if done properly and at the right time
• anti-inflammatory medication, if necessary, as prescribed by your physician
• therapeutic modalities: ultrasound, interferential current, etc...
• cortisone injection ~ only if necessary, by your physician

HOW DO I PREVENT IT?

• avoid overuse be smart and gradually increase intensity, frequency, and duration of play
• avoid technique errors - get a lesson or two!
• make sure equipment is adequate - get a ‘tune-up’ if necessary
• improve flexibility and strength of forearm muscles
• maintain mobility of all upper extremity joints, including wrist, shoulder, and neck too!

WHAT ELSE CAUSES PAIN IN THIS AREA?

• joints of the cervical and upper thoracic spine
• muscles of the shoulder region
• elbow ligaments
• elbow joint arthritis
• nerve entrapment ~ pinched nerve
• adverse neural tension in the upper extremity
• periostitis ~ inflammation of the bone
• bursitis at the elbow
• rheumatoid arthritis, gout and other systemic disorders

YOUR PHYSIOTHERAPIST CAN HELP YOU WITH THE REST…