Lateral Epicondylitis (Tennis elbow)
The muscles of the forearm that bend the wrist back (extensors) begin at the lateral epicondyle, from a common tendon attachment. Bending the wrist back (extension), turning the hand palm side up, and lifting an object with the elbow straight are the more common activities that affect these tendons. More about Anatomical Terms
Anatomy of the Elbow
Lateral Epicondylitis is a common condition that causes pain at the outside bump (or epicondyle) of the elbow. Tennis is not the only cause of this condition (it is common in all racquet sports), but tennis players do get the condition usually as a result of overuse of the muscles/tendons used to hit a backhand shot.
Causes of Lateral Epicondylitis
One theory on the cause of lateral epicondylitis is that small tears in the tendon occur through overuse. They begin to heal but when reinjured by continued use, the tendons seem to finally give up on trying to heal and a condition called angiofibroblastic degeneration begins to take over. Think of this as scar tissue that never reaches maturity and remains weak and painful. Others feel that the tendon changes are primarily a result of decreased blood flow in the area, a sort of heart attack of the tendon. The end result is still the formation of the angiofibroblastic tendinosis tissue. The same events can happen with repeated strains like hammering a nail, picking up a heavy bucket, or pruning shrubs.
Other causes are from overuse from the repetitive motions of racquet sports like tennis and squash.
Symptoms Lateral Epicondylitis
Symptoms include tenderness and pain at the lateral epicondyle, made worse by extending the wrist or gripping. Tenderness and pain usually begin at the lateral epicondyle. Pain may spread down the forearm with soreness felt in the forearm muscles. Activities like grasping can make matters worse. Activities such as reaching into the refrigerator to get a gallon of milk can be a painful process! Some patients actually lose some motion in the elbow, usually a few degrees of extension (meaning they can’t completely straighten the elbow.)
Diagnosis of Lateral Epicondylitis
The diagnosis can usually be made from your history—how you got hurt—and physical examination alone. X-rays of the bones in the elbow may be needed if your symptoms suggest the possibility of a serious problem with the joint. Depending on the findings you may need an ultrasound or MRI to see the soft tissues in the elbow.
Preventing and Treating Lateral Epicondylitis
Treatment usually begins with first aid. Some of the common modalities of management include the following:
Ice decreases the size of blood vessels in the sore area, halting inflammation and relieving pain. Choices of application include cold packs, ice bags, or ice massage. Ice massage is an easy and effective way to provide first aid. Simply freeze water in a paper cup. When needed, tear off the top inch, exposing the ice. Rub three to five minutes around the sore area until it feels numb.
Resting the sore area will prevent further injury while allowing time to heal. A nonelastic elbow wrap (sometimes refferred to as a tennis elbow strap or lateral epicondylitis band) can help rest the damaged area of the tendon. These straps work by spreading the muscle forces to a larger area of the elbow. A neutral wrist splint holds the wrist in a safe position while limiting stresses at the elbow. In the early stages of healing, finger movement should also be minimized due to potential forces placed on new scar formation. Pain with activity is a sign that irritation of the area is occurring. Avoid movements and activities that increase pain. Decrease repetition and try to lift or pull with your palms upward.
- Specific rest:
Performed slowly, lateral epicondylitis exercises including range of motion at the wrist, forearm, and elbow will keep these joints from becoming stiff while preventing further injury to the elbow.
Wrist: Move the wrist in one of four directions.
Forearm: Turn the forearm up or down.
Elbow: With the forearm resting outward on a smooth surface, slowly bend and straighten the elbow.
- Isometric Exercises:
This means “same length.” Though the muscle tightens, no movement takes place at the joint. The resistance may be applied with the joint in neutral, at the limits of motion, or at various angles in between. Avoid pain.
Multiwrist: Block movement in the hand of the sore arm. Attempt to move it in one of four directions (ie. up, down, side, side).
Forearm: Holding the forearm, attempt to turn it either up or down.
Elbow: Without allowing it to move, try to bend the elbow up, then down.
If your surgeon suggest surgery, you may want to get a second opinion for surgery.
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