Lateral epicondylalgia.

I am guessing most of you have never heard of this term and I promise it is English. It is the technical name for a condition most people know as… Tennis Elbow. This condition has had more names than Federer has tennis trophies (almost!) – but whatever you like to call it, it all refers to the same injury. In today’s blog we are going to look further into the symptoms, causes and treatment for this pesky elbow condition.

Roger Federer backhand

Image courtesy: Tennis News Surge

So, what is Tennis Elbow?

Tennis Elbow is an injury to the tendon of the muscles that extend the wrist and fingers. These muscles originate on the lateral epicondyle, which is a bony protuberance on the outside of the elbow, and run down the forearm to your fingers, on the backhand side. The condition is called Tennis Elbow because it affects the forearm muscles tennis players use to hit a backhand… and is a common cause of injury to tennis players. In fact, current statistics approximate 40% worldwide!

Tennis Elbow components

Image courtesy: Sport and Spinal Physiotherapy

Symptoms

Tennis Elbow symptoms may last for a few days, weeks, months, or years. Typically the Tennis Elbow pain is felt with gripping tasks like holding a water jug, hammering a hammer or even something as tiny as a knitting needle. It can also be felt with repetitive tasks like typing, painting or folding clothes, just to name a few!

Pain will be felt when these forearm muscles are resisted. It can also be present when the muscles are stretched. There will be tenderness directly over the bony epicondyle.

Studies have shown that 80% of people who have Tennis Elbow pain for more than 6 weeks will also have associated neck issues!

What causes Acute Tennis Elbow?

Acute Tennis Elbow is caused by damage to the tendon/muscle tissue at the point it joins the lateral (outer) elbow. It occurs when more force is applied to an area than the normal healthy tissues can handle. This may occur over a short period of time with a new activity or progress slowly over a long period of time with continuous stress. Common Tennis Elbow causes include:

  • Unaccustomed hand use e.g. painting a fence, hammering, lots of typing, gardening (15% of those working in repetitive manual trades will be suffering from Tennis Elbow)
  • Excessive gripping or wringing activities (talking from experience… learning to water ski!)
  • Weak or tight forearm muscles
  • Poor technique using equipment or tools

In some cases, Chronic Tennis Elbow can develop due to the soft tissues already being in poor health – lending themselves to easy injury. Inflammation follows the injury, which leads to swelling and elbow pain.

What causes Chronic Tennis Elbow?

Chronic Tennis Elbow is associated with degenerative changes in the muscle tissues at the epicondyle. For a long time, this was thought to be related to inflammation from overuse (aka tendinitis). We now know this to be incorrect.

Chronic Tennis Elbow is NOT due to INFLAMMATION

Testing of Chronic Tennis Elbow sufferers has shown no evidence of the chemicals normally associated with inflammation. Instead, there is an increase in chemicals associated with pain transmission in the nerves. This is coupled with changes in the blood supply, and changes in the coordination of the muscles when using the hand and wrist. You also see degenerative changes in the extensor tendon, where the tendon structure starts to break down.

How is it diagnosed?

A physiotherapist or doctor will be able to diagnose you with Tennis Elbow after hearing your history and performing a few clinical tests. An ultrasound scan or MRI are the best tests to identify any tendon tears or inflammation. X-rays are of little diagnostic benefit for Tennis Elbow injuries.

Common differential diagnosis may be referred pain from your cervical spine (neck) joints or radial nerve tension. These issues can often mimic your elbow pain. Again, clinical tests can normally confirm if your pain is referred from your neck or not.

What are my treatment options?

  • Forearm muscle strengthening++
  • Massage
  • Dry Needling
  • Mobilisation of your neck and elbow joints
  • Elbow taping
  • Forearm flexor and pronator muscle stretches
  • Neural mobilisations
  • Tennis Elbow brace
Dry Needling Tennis Elbow

Image courtesy: Sport and Spinal Physiotherapy

Elbow BraceImage courtesy: Physio Room

Should I have a cortisone injection?

Generally, the answer is “no”, especially if injected into the tendon. This can damage the tendon and in turn, cause yet more damage. Recent studies have shown steroid injections around the tendon provide some people with initial pain relief (first 3-6 weeks). However, a high percentage of Tennis Elbow sufferers will have their pain return in a worse state after 12 months if they have a injection without any physiotherapy. Recent studies have shown physiotherapy more effective than general advice alone and much more effective than cortisone injections at 12 months. For this reason, researchers do not recommend cortisone injections as a stand-alone treatment for Tennis Elbow.

We hope today’s blog has answered a few of those questions you have about Tennis Elbow. If you think you might have Tennis Elbow, and want an expert opinion and treatment, the team at Revive Physiotherapy and Pilates have years of experience dealing with the condition. Make an appointment today by calling 9391 2600 or booking online. They will have you back on court, or back on the tools, in no time!