Tennis elbow, also referred to as lateral epicondylitis is a condition where the outer part of the elbow becomes tender and sore. The inflammation can be chronic or acute and will involve the tendons connecting the outside part of the elbow which is referred to as the lateral epicondyle and the forearm muscles. In this condition, the damage of the tendons and forearm muscles will be as a result of overuse that involves repetitive strenuous movements. This overuse leads to pain, tenderness and inflammation on the outer part of the elbow.
The first description of this condition is credited to Runge in 1873 with the term ‘tennis elbow’ first appearing in 1883 paper by Major which was dubbed Lawn-tennis elbow. Tennis involves repetitive movements of the arm which utilize the forearm extensor muscles and this is what can lead to the chronic or acute tendonitis affecting the tendinous insertion of the muscles around the elbow’s epicondyle. This condition has been found to be common in athletes, carpenters and other laborers who swing tools such as a harmer using their forearm.
Signs and Symptoms of Tennis Elbow
The symptoms that most patients will experience include the following:
- Point tenderness experienced on the prominent part of the bone on the outer part of the elbow (The lateral epicondyle)
- Pain will be felt in the lateral epicondyle
- Pain will be experienced when making gripping wrist movements especially when lifting or when making extension movements.
- Pain is also associated with the use of wrist extension movements such as pouring liquid from a container, sweeping, or lifting with palm down.
- Most patients have reported morning stiffness.
Other symptoms may include pain during the extension of the wrist, forearm weakness, pain radiating from the outer part of the elbow all the way to the forearm and the wrist, pain experienced during a handshake and doorknob turning, inability to hold items that are relatively heavy using the hand. This pain is similar to the pain experienced by golfer’s elbow patients only that the latter is experienced in the medial side.
Causes of Tennis Elbow
The most common opinion is that tennis elbow is a condition caused by the overuse of tendons around the elbows accompanied by failed normal healing of these tendons. Extensor Capri radials brevis muscles have also been found to play a major role in the development of this condition. There were initial experiments that suggested that the condition was as a result of overextension. Overextension is still a cause but other causes have been identified.
Studies have indicated that trauma is also a cause especially a blow to the epicondyle, forceful extension, and a sudden forceful pull. Playing tennis incorrectly will also cause tennis elbow because there is shock caused by the wrong hitting of the tennis ball.
There is a proposed explanation by Cyriax of the occurrence of the tennis elbow. This hypothesis explains that there are macro and microscopic tears that occur between the lateral humeral epicondyle periosteum and the common extensor tendon. In a study involving 39 patients, 28 had tearing of the tendon cuff. Kaplan stated that the radial nerve was a key player in tennis elbow. He identified a constriction of the radial nerved caused by the adhesion to the radiohumeral joint capsule and the short wrist extensor muscle. Chances of tennis elbow developing are increased by certain disorders such as the bicipital tendinitis, carpal tunnel syndrome or calcification of the rotator cuff.
Experience and ability are other factors in tennis elbow. Most of the players who reported tennis elbow history had played for a number of years. Just like any other sport, poor techniques in playing tennis will increase the risk of tennis elbow development. This means that players should learn how to properly hold the racket and swing to hit the ball to avoid any injuries. Professional tennis players on the competitive level will report this condition more than novices and lower class players. However, because of the wrong techniques, a lot of cases are also reported as the level of ability decreases.
There are other ways to prevent this condition such as the reduction of play time if there is some pain experience or an injury to the outer part of the elbow. The players should stay in good shape. This should include the strengthening of the muscles of the forearm the upper back and the shoulder. The increased strength will aid in stabilizing the elbow joints. Equipment should be used appropriately and the player should learn how to balance between their muscular strength, body size and ability.
Diagnosis of Tennis Elbow
Most physicians will perform tests where they press on the affected elbow and ask the patient to move the wrist, fingers and elbow. X-rays may be used in ruling out any other conditions that might be causing the pain and are not associated with tennis elbow such as arthritis or bone fractures. The diagnosis also uses signs and symptoms that are characteristic and discrete. This might include point of tenderness with a fully extended elbow. Pain with passive flexion of the wrist and resistive extension of the wrist might be used in the diagnosis. When there is a middle finger resisted extension, the condition might be affecting the extensor digitorum.
Treatment of Tennis Elbow
Lateral epicondylitis treatment evidence is still poor. In some cases, patients have reported the mending of the symptoms without treatment in a period of between 6 and 24 months. Tennis elbow, when left untreated, can cause chronic pain and this will generally lower the quality of life and affect daily life activities. Treating a minor tennis elbow is a simple as relaxing the affected arm.
NSAIDs may be used on a short term basis to relieve the pain. There is poor evidence on the effectiveness of different injections. Surgery becomes an option only when the case is recalcitrant. Most cases will respond to therapy but there are chances of relapse especially when the individual has to go back to the movements that caused the condition in the fits place.