TENIS ELBOW (Lateral Epicondylitis)

Tennis elbow (lateral epicondylitis) is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. However, several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care.

Anatomy

Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.

The ECRB muscle and tendon is usually involved in tennis elbow.

Muscles, ligaments, and tendons hold the elbow joint together.

Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Cause

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities or jobs involving repetitive arm motion also cause tennis elbow. They include:

·         Painting

·         Tree-cutting

·         Carpentry

·         Playing some musical

·         Repetitive computer mouse use

Also, cooks, butchers, and assembly-line workers are among those who often suffer tennis elbow.

Note: Tennis elbow is different from Golfer’s elbow even though tendon tears are caused by repetitive movements of the hands. Because, the pain in Golfer’s elbow is focused on the inside of the elbow.

Symptoms

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with

the start of symptoms.Common signs and symptoms of tennis elbow include:

·         Pain or burning on the outer part of your elbow

·         Weak grip strength

The ache on the outside of the elbow is the major symptom of tennis elbow, which may affect both the arms.

The ache may turn into a chronic pain over time.Eventually, it may become difficult even to lift things.Pain and weakness may make it difficult even to shake hands, turn a door knob, or even hold a coffee cup.The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Doctor Examination

consider many factors in making a diagnosis. These include how your symptoms developed, any occupational risk factors, and recreational sports participation.

what activities cause symptoms and where on your arm the symptoms occur. History of rheumatoid arthritis, injured your elbow or nerve disease.use of variety of tests to pinpoint the diagnosis. For example, try to straighten your wrist and fingers against resistance with your arm fully straight to see if this causes pain. If the tests are positive, those muscles may not be healthy.

Tests

recommend additional tests to rule out other causes of your problem.

·         X-rays. These tests provide clear images of dense structures like bone. They may be taken to rule out arthritis of the elbow.

·         Magnetic resonance imaging (MRI) scan. If symptoms are related to a neck problem, an MRI scan may be ordered. MRIs scans show details of soft tissues, and possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

·         Electromyography (EMG).  rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Treatment 

Nonsurgical Treatment

        Approximately 80% to 95% of patients have success with nonsurgical treatment.

    Rest: The first step toward recovery is to give your arm proper rest. This means that you   will have to stop participation in sports or heavy work activities for several weeks.

·  Physical therapy: The therapist helps gradually stretch and strengthen muscles, especially of the forearm. Eccentric exercises help big time, as they involve lowering and raising the wrist very slowly. The doctor may suggest the brace or the forearm strap to reduce stress on the injured tissue. 

     Medications as prescribed by the doctor including aspirin, ibuprofen, Motrin, Advil. Over the counter pills may also offer reduce pain and swelling.

  Surgical or other procedures:

 (i) Injections: To control the pain, the doctor might suggest injecting platelet-rich plasma, Botox or some irritant (prolotherapy) into the painful tendon. Dry needling can also help, which is nothing but piercing needles at the damaged tendon in many places. 

(ii) Ultrasonic tenotomy (TENEX procedure): It is a medical procedure that involves inserting a special needle through the skin under ultrasound guidance into the damaged portion of the tendon. The needle is vibrated swiftly by the ultrasonic energy for the damaged tissue to get liquefied and can be suctioned out. 

(iii) Surgery: Even after the 6 to 12 months treatment if the pain does not subside, a surgery may become the option for the removal of the damaged tissue. Such procedures can be performed through several small incisions or a large incision. Rehabilitation exercises play a prominent role in recovery.

· Lifestyle and home remedies: Rest so that the elbow pain doesn’t exaggerate. Expert-evaluation to analyze the tennis techniques and movements to correct and take right measures to reduce the stress on the injured tissues. Self-care measures like applying ice bags or a cold pack for 15 minutes at least thrice a day will be helpful.

·         Exercising as per the expert guidance.

What Are The Strengthening Exercises For Tennis Elbow:Strengthening exercises for Tennis elbow are listed below.

Ball or sock squeeze:

1.      Hold tennis ball in your hand.

2.      Make a fist and squeeze.

3.      Hold for 6 seconds and release.

4.      Repeat 10 times a day. Repeat in both the hands.

Wrist deviation

1.      Sit by resting your arm on a flat surface and leaving your hand hanging off the edge.

2.      Move your hand up and down. Keep repeating the motion for 8 to 12 times.

3.      Repeat by switching arms.

Wrist Curl exercises

1.      Sit placing your forearm on a table, palm up, and hand hanging over the edge.

2.      Place an object that weighs around 1 to 2 pounds in your hand.

3.      Slowing keep raising and rest forearm on the table.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Bicep curls

1.      Lean forward and sit with legs spread little.

2.      Place your left hand on your left thigh. Right hand on the right thigh.

3.      Hold weight with your forearm. Curl the weight slowly toward the chest.

4.      Keep repeating the motion for 8 to 12 times. Switch arms.

Overview

Tennis elbow or lateral epicondylitis is a painful condition that occurs due to overuse and muscle strain injury.

Occurs when elbow tendons are overloaded due to repetitive motions of arm and the wrist.

Over-the-counter pain relievers and enough rest help relieve tennis elbow. Surgery may be a last option if all the conservative treatments fail or if the symptoms are disabling.