Tennis Elbow/Lateral Epicondylitis Explained
Why Does Tennis Elbow Occur?
Everything that might overload the extensor tendons of the forearm, notably when our palm gets into a position facing down, can promote micro tears and inflammation seen in Lateral epicondylitis/tennis elbow.
Such types of activities include
Repeated gripping or holding activities idiopathically driven two-wheeler riding, playing tennis, carrying and pushing heavy objects
Activities like typing words of tools on a daily basis cause the extensor muscle to a repetitive load. is a painful condition that occurs when the tendons in your elbow are overworked, usually by repetitive motions of the wrist and arm.
Direct trauma or blow to the elbow can bring about inflammation of a tendon resulting in degeneration as well.
Symptoms
Bothering outer elbow symptoms, most notably. The lateral epicondyle is the bony point of tenderness. Pain increases with activities such as gripping, pushing, and grasping Pain may be experienced localized to the lateral epicondyle, but some patients could have pain radiating down to the forearm.
Diagnosis
These types of injuries are usually very suggestive history and clinical examination but can be confirmed by imaging (Ultrasound or MRI elbow).
Treatment
Had I wanted to take the more conservative approach, I could have only stopped or substantially slowed doing simple tasks like typing or gripping. Anti-inflammatory medications may be prescribed for patients. Tennis Elbow Splints/Braces: These braces can help take some of the strain off the elbow extensors. Manual massage, ice massage, or modalities like Ultrasound in physical therapy have been used to provide symptomatic relief of lateral epicondylitis. Taping the painful elbow can be another approach used in addition to these.
Tennis Elbow Exercise Protocol
Stretching and strengthening the muscle groups involved are essential to any rehabilitation program. Exercises broadly include
- Forearm extensor
- stretch
- The muscular eccentric Extensors of the Wrist
- Wrist Extension Isometric Strengthening
- Isotonic Wrist Extensor Strengthening
Anti-Inflammatory injection- Corticosteroids can be blindly injected over the inflammation or image-guided using an imaging modality (eg. Multidetector CT scanner/X-ray) to restain the inflammation so that the patient can take rehabilitation). Steroid injections should not be given in the same area back-to-back
PRP and Phototherapy
This is a very good treatment with Ultrasound-guided platelet-rich plasma with Prolotherapy) as it works to heal the damaged tendon. So, 2-3 sittings of PRP with prolotherapy along wed regular exercises have been quite effective in controlling the troublesome symptoms of tennis elbow.
Stem Cells: Stem Cell injection has been attempted in a few chronic cases into the damaged tendon.
Surgery- Arthroscopic: (or) open surgery for removal of the degenerated tendon in chronic, resistant cases not responding to non-operative means.
Forearm extensor stretch
Keep your arm straight and bend the elbow slightly.
Now just curl your fingers and the other hand over your knuckles. Pull the affected arm hand and wrist gently further inward until you can feel a small stretch along your arm. You want to make certain that there is some pressure from the pull in your arm, but you should not be pulling so hard that the pull hurts.
Eccentric Lean-to Fist with the Wrist Extensors
- Gently place your affected arm on a table with the hand hanging free over the edge.
- Use the other hand to raise the hand of the affected arm into elevation. Maintain this grip with your hand as you release the hand assisting.
- Gently encourage the hand of your affected arm to return to neutral (hanging). They then lower the weight back down in a slow manner which is referred to as “controlled release” or an “eccentric muscle contraction”.
Isometric wrist extensor strengthening
- Place your affected arm on a flat surface with your wrist extended beyond the edge of the table.
- Apply downward pressure on the hand of the affected arm with one of your hands while keeping the wrist out straight.
Wrist Extensor Isotonic Strength
Place the arm of those affected face down on a table or in your lap, and let your hand hang over the edge.
Lift and lower your hand by bending the wrist.
These are the joints at which the muscle attaches to the bone via tendons. In this condition, the involved muscle, the Extensor Carpi Radialis Brevis, is an important wrist extensor for maintaining the stability of the wrist.
Cause
Tennis elbow, on the other hand, is when you damage some of the muscles in your forearms that aid you in extending your wrist and fingers. Excess or repeated stress to the tissue can cause small tears in the tendons that connect on the outside of the elbow.
Tennis elbow can develop if any activity is played on the upper limb in pronation performed by turning the arms face down. These activities include:
- Similar jobs are performed several times: Typing, using tools, etc.
- Activities that require prolonged gripping, such as riding a motorcycle or bicycle, working with vibrating tools, and pushing or carrying heavy loads.
- Trauma: A direct blow to the elbow can cause the tendon to swell, which may trigger degeneration. A rapid force or activity also could harm the tendon.
Who gets it?
Most people with this condition are between ages 30 and 50, although it can occur in those younger and older, as well as in both men and women.
Signs and Symptoms
Patients historically seek medical attention for pain. Pain over the lateral (outside) aspect of the elbow, over an area of bone called the lateral epicondyle. And this area gets sore when you touch it. Any activity which overloads the tendon, such as gripping or lifting, will cause pain. Pain with activity usually starts at the elbow and may travel to the hand down the forearm. Sometimes, pain can occur with any elbow motion. Tennis elbow pain may develop gradually or can occur suddenly. Symptoms can include
Care at home Home care Management of tennis elbow
- Adjusting activity and rest: In the short term, the FFWZ as a condition should be reduced – Rather, the recommendation is to limit that aggravating activity; not total rest.
- Medicine: Anti-inflammatory medicine might help control the pain.
- Brace: wearing a tennis elbow brace, which is worn around your forearm muscle and just below the elbow will decrease tension on the tendon making it easy to heal.
- Taping: Tape your elbow to provide support to the soft tissues. You may want to consult a physical or occupational therapist on how to tape your elbow.
- Apply ice-icing the knee multiple times per day helps reduce pain.
- Ice pack application: Hold the ice pack up to your skin with a towel. Apply the ice pack to the painful area for 15–20 minutes. Every five minutes, check your skin to make sure you are not damaging it.
- Ice massage: Apply an ice pack, and massage around the elbow area for about 5 mins as a loop process [14].
- Manual massage: A good massage is known to help improve blood circulation, reduce sensitivity, and relieve pain in the bladder. Learn how to massage from a physical or occupational therapist.
Exercises
This May Help Stretching and Strengthening for Tennis Elbow Exercising helps to keep the muscles strong so that they can support you as your body recovers. For many people, this relief from pain starts almost immediately after exercise.