Tennis Elbow

Tennis elbow or lateral epicondylitis is a common painful condition that causes tenderness and swelling around the outer or lateral elbow. It is normally as a result of overuse or repetitive strain injury especially from activity involving gripping (not just tennis). Golfer's elbow or medial epicondylitis is a similar condition affecting the inner elbow.

When gripping most of the power is generated by the muscles of the forearm with the small muscles of the hand acting as 'fine tuners'. Many of the powerful forearm muscles attach to the humerus bone at a small area called the Common Extensor Origin and tremendous forces can be applied it by the muscles especially extensor carpi radialis brevis and extensor digitorum longus. It is this area that is affected in tennis elbow. The junction between the tendons and the bone (periostium) becomes inflammed resulting in a periostitis.

Signs and Symptoms of Tennis Elbow

The primary complaint is pain and tenderness on the outside of the elbow aggravated by gripping, lifting or wrist extension. The pain is relieved by rest and often feels substantially better after a nights sleep. The clinician, after a full case history, may apply pressure to the area which will reproduce the pain and then ask the patient to grip something. If there is pain when making a fist whilst the wrist is passively flexed then a diagnosis of lateral epicondylitis may be made.

Treatment and Management of Tennis Elbow

The acute phase or early part of the condition may respond to a combination of ice, rest, manual therapy (like osteopathy, chiropractic or physiotherapy) and gentle stretch. Anti inflammatory medication may be useful. Support for the area in the form of elbow braces can be helpful. It is important to address the habits and life style of the sufferer. If tennis is the culprit then increasing the grip size can help. Improving the sufferers work station or ergonomics is advised and tennis elbow can occur if the shoulder or upper back and neck are stiff. Desk Therapy exercise software can be very useful in improving the range of movement in the neck, shoulders and back using gentle stretches and desk exercises for computer users. If the condition doesn't respond then it can enter the chronic phase

Tennis elbow is considered chronic if the condition lasts longer than twelve weeks and can be hard to treat. Cortisol injections may sometimes be of benefit but can have unwanted side effects like thinning of the connective tissue (ligaments, muscles, bone). The sufferer will often have to reduce the amount of use of the affected arm and complete a course of physical therapy like osteopathy. This should involve stretches and strengthening exercises to maintain good mobility of the neck, shoulders and upper back. A work station assessment would again be useful. Desk Therapy exercise software can be a useful addition for the management of chronic tennis elbow. Other treatments to consider are acupuncture, laser therapy, cortisol injection and finally surgery if the condition is progressive and not responding to any other measures.