Tennis Elbow

Tennis elbow is an overuse injury occurring in the lateral side of the elbow region, but more specifically it occurs at the common extensor tendon that originates from the lateral epicondyle. The acute pain that a person might feel occurs as one fully extends the arm.
In one study, data was collected from 113 patients who had tennis elbow, and the main factor common to them all was overexertion. Sports persons as well as those who used the same repetitive motion for many years, especially in their profession, suffered from tennis elbow. It was also common in individuals who performed motions they were unaccustomed to. The data also mentioned that the majority of patients suffered tennis elbow in their right arms.

Signs and Symptoms

 Pain on the outer part of elbow (lateral epicondyle).
 Point tenderness over the lateral epicondyle – a prominent part of the bone on the outside of the elbow.
 Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.
 Activities that use the muscles that extend the wrist (e.g. pouring a a kettle of water, lifting with the palm down) are characteristically painful.
 Morning stiffness.
The symptoms associated with tennis elbow are, but are not limited to: radiating pain from the outside of your elbow to your forearm and wrist, pain during extension of wrist, weakness of the forearm, a painful grip while shaking hands or torquing a doorknob, and not being able to hold relatively heavy items in the hand. The pain is similar to the pain of the condition known as Golfer’s elbow but the latter occurs at the medial side of the elbow.

Causes
During early experiments, it was thought that tennis elbow was primarily caused by overexertion. Studies have shown that trauma such as direct blows to the epicondyle, a sudden forceful pull, or forceful extension have caused more than half of these injuries.
One explanation of how tennis elbow may come about is proposed by Cyriax. The theory states that there are microscopic and macroscopic tears between the common extensor tendon and the periosteum of the lateral humeral epicondyle. An operation conducted in this study showed that 28 out of 39 patients showed tearing at the tendon cuff. Kaplan stated that the radial nerve was significantly involved in tennis elbow. He noted the constriction of the radial nerve by adhesions to the capsule of the radiohumeral joint and the short extensor muscle of the wrist. Evidence found that many differed in how they contracted tennis elbow. Disorders such as calcification of the rotator cuff, bicipital tendinitis, or carpal tunnel syndromemay increase chances of tennis elbow.

Prevention

 Decrease the amount of playing time if already injured or feel pain in outside part of elbow
 Stay in overall good physical shape
 Strengthen the muscles of the forearm (Pronator quadratus, Pronator teres and Supinator muscle), the upper arm (biceps, triceps, Deltoid muscle), the shoulder and upper back (trapezius)
 Increased muscular strength will increase the stability of joints such as the elbow
 Like other sports, use equipment appropriate towards your ability, body size and muscular strength.

Diagnosis

The diagnosis is made by clinical signs and symptoms, which are both discrete and characteristic. With the elbow fully extended, there are points of tenderness over the affected point on the elbow, which is the origin of the extensor carpi radialis brevis muscle from the lateral epicondyle (extensor carpi radialis brevis origin). There will also be pain with passive wrist flexion and resistive wrist extension (Cozen’s test).

Treatment

Physical

There are several recommendations regarding prevention, treatment, and avoidance of recurrence that are largely speculative including stretches and progressive strengthening exercises to prevent re-irritation of the tendon and other exercise measures.

Evidence suggests that joint mobilization with movement directed at the elbow resulted in reduction in pain and improved function.[15] Positive results have been found with manipulative therapy directed at the cervical spine, although data regarding long-term effects were limited.[16] Low level laser therapy administered at specific doses and wavelengths directly to the lateral elbow tendon insertions offers short-term pain relief and less disability in LET, both alone and in conjunction with an exercise regimen.
Over the past 16 years in clinical practice, I have found that the tennis elbow or supinator strap or clasp is very useful in taking the strain off of the damaged extensor tendons. It is very easy to use and give the damaged tendon an opportunity to regroup and start healing.

Medication

Topical non-steroidal anti-inflammatory drugs (NSAIDs) to relieve lateral elbow pain in the short term, however there were no improvements found in functional outcomes. Injected NSAIDs were suggested to be better than oral NSAIDs. There was insufficient evidence to recommend or discourage the use of oral NSAIDs.
Corticosteroid injection are effective in the short term however are of little benefit after a year compared to a wait and see approach. Complications from repeated steroid injections include skin problems such as hypopigmentation and fat atrophy leading to indentation of the skin around the injection site.
Botulinum toxin type A to paralyze the common extensor origin chronic tennis elbow that has not improved with conservative measures.

Surgery

The last resort. In recalcitrant cases, surgery may be an option.