What is Tennis elbow?

A health article about Tennis elbow from Muscle Disorders the A to Z directory of
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This condition is a common elbow injury of racket sport players and manual laborers. Tennis elbow is an overuse injury resulting from the performance of repetitive motions with the hand and forearm, such as swinging a tennis racket or a hammer though it is not necessary for be playing sport to find you are suffering from the condition.

Such repetitive motions can cause inflammation of the muscles of the forearm. The symptoms of tennis elbow include pain, soreness, and weakness in the muscles on the outside of the forearm.

The treatment of this condition is usually conservative, relying on rest, ice, and anti-inflammatory medication.

Tennis elbow, or lateral epicondylitis is an inflammation of several structures of the elbow. These include muscles, tendons, bursa, periosteum, and epicondyle (bony projections on the outside and inside of the elbow, where muscles of the forearm attach to the bone of the upper arm).

Description

The classic tennis elbow is caused by repeated forceful contractions of wrist muscles located on the outer forearm. The stress, created at a common muscle origin, causes microscopic tears leading to inflammation.

This is a relatively small surface area located at the outer portion of the elbow (the lateral epicondyle). Medial tennis elbow, or medial epicondylitis, is caused by forceful, repetitive contractions from muscles located on the inside of the forearm.

All of the forearm muscles are involved in tennis serves, when combined motions of the elbow and wrist are employed. This overuse injury is common between ages 20 and 40.

People at risk for the condition are those in occupations that require strenuous or repetitive forearm movement. Such jobs include mechanics or carpentry. Sport activities that require individuals to twist the hand, wrist, and forearm, such as tennis, throwing a ball, bowling, golfing, and skiing, can cause tennis elbow.

Individuals in poor physical condition who are exposed to repetitive wrist and forearm movements for long periods of time may be prone to tennis elbow. This condition is also called epicondylitis, lateral epicondylitis, medial epicondylitis, or golfer's elbow, where pain is present at the inside epicondyle.

Causes and symptoms Tennis elbow pain originates from a partial tear of the tendon and the attached covering of the bone. It is caused by chronic stress on tissues attaching forearm muscles known as extensor muscles to the elbow area.

Individuals experiencing the condition may complain of pain and tenderness over either of the two epicondyles. This pain increases with gripping or rotation of the wrist and forearm. If the condition becomes long-standing and chronic, a decrease in grip strength can develop.

Diagnosis

When attempting to diagnosis tennis elbow, a doctor or physical therapist will test for tenderness on or near the bony knob of the elbow joint.

Pain that increases when bending the wrist back is also indicative of tennis elbow. Pain related to the condition also increases when gripping. Thus, shaking hands may be painful. Finally, a perception of weakness or chronic muscle fatigue in the forearm muscles is an indicator of tennis elbow.

Diagnosis of tennis elbow includes the individual observation and recall of symptoms, a thorough medical history, and physical examination by a physician. Diagnostic testing is usually not necessary unless there may be evidence of nerve involvement from underlying causes.

X rays are usually always negative because the condition is primarily soft tissue in nature, in contrast to a disorder of the bones. However, magnetic resonance imaging (MRI) has been shown to be helpful in diagnosing cases of early tennis elbow because it can detect evidence of swelling and tissue tears in the common extensor muscle group.

Treatment

Treatment for the condition is usually conservative and passive. Most importantly, people with tennis elbow should avoid the activities that cause forearm pain (e.g., playing tennis) until the injury heals. Rest will often correct tennis elbow in a matter of weeks.

In addition, the use of ice and anti-inflammatory medications can ease pain and promote healing. Physical therapy and heat therapy may also hasten the healing process. Finally, upon returning to regular activity, wearing an elbow and forearm brace can prevent recurrence of tennis elbow.

Elbow braces, available at drug stores, help prevent tennis elbow by restricting movement and use of the elbow.

Because treatment of tennis elbow and recovery from tennis elbow can be a long, frustrating process, prevention is the best strategy. For tennis players, several equipment adjustments can help prevent tennis elbow. Players should select a racket with a midsized racket head (90 - 105 square inches) and high flexibility (stiffness index lower than 65).

Additionally, players should string their rackets with soft strings such as synthetic nylon or natural gut at the low end of the recommended tension range. Finally, to prevent tennis elbow, players should ensure that the grip of their racket is neither too large nor too small.

Conservative

Heat or ice is helpful in relieving tennis elbow pain. Once acute symptoms have subsided, heat treatments are used to increase blood circulation and promote healing. The physician may recommend physical therapy to apply diathermy or ultrasound to the inflamed site.

These are two common modalities used to increase the temperature of the tissues in order to address both pain and inflammation. Occasionally, a tennis elbow splint or taping may be useful to help decrease stress on the elbow throughout daily activities.

Exercises become very important to improve flexibility to all forearm muscles, and will aid in decreasing muscle and tendon tightness that has been creating excessive pull at the common attachment of the epicondyle.

The physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce inflammation and pain. Injections of cortisone or anesthetics are often used if physical therapy is ineffective. Cortisone reduces inflammation, and anesthetics temporarily relieve pain.

Physicians are cautious regarding an excessive number of injections as they have been found to weaken the tendon's integrity. In addition, a significant number of patients experience a temporary increase in pain following corticosteroid injections.

A newer method of treatment for the condition is shock wave therapy, in which pulses of high-pressure sound are directed at the injured part of the tendon. The "shock" refers to the high pressure, which breaks down scar tissue and stimulates the regrowth of blood vessels in healthy tissue.

Shock wave therapy sessions take about 20 minutes and have been reported to have a success rate of 80%. Shock wave therapy has very few side effects; one group of German physicians found that temporary reddening of the skin or small bruises were the most commonly reported side effects.

Botulinum toxin, or Botox, is also being tried as a treatment for tennis elbow as of late 2003. Although further research needs to be done, Botox appears to relieve pain in chronic tennis elbow by relaxing muscles that have gone into spasm from prolonged inflammation.

Surgery

If conservative methods of treatment fail, surgical release of the tendon at the epicondyle may be a necessary form of treatment. However, surgical intervention is relatively rare.

Alternative treatment

Massage therapy has been found to be beneficial if symptoms are mild. Massage techniques are based primarily on increasing circulation to promote efficient reduction of inflammation. Manipulation, acupuncture, and acupressure have been used as well.

Contrast hydrotherapy (alternating hot and cold water or compresses, three minutes hot, 30 seconds cold, repeated three times, always ending with cold) applied to the elbow can help bring nutrient-rich blood to the joint and carry away waste products.

Botanical medicine and homeopathy may also be effective therapies for tennis elbow. For example, cayenne (Capsicum frutescens) ointment or prickly ash (Zanthoxylum americanum) oil applied topically may help to increase blood flow to the affected area and speed healing.

Prognosis

The condition is usually curable; however, if symptoms become chronic, it is not uncommon for treatment to continue for three to six months.

Prevention

Besides equipment adjustments, tennis players (and others) attempting to prevent the condition can follow several guidelines related to physical activity. First, strengthening the muscles of the hand, wrist, and forearm is perhaps the best way to prevent tennis elbow.

Strengthening these muscles helps reduce strain on the elbow itself. Appropriate and effective wrist and forearm exercises include wrist curls and extensions (with very light weights), squeezing a tennis ball in the palm of the hand, and placing a rubber band around the fingers and extending the fingers.

In addition to strengthening exercises, it is important that tennis players consult a tennis professional to ensure that their strokes are efficient, correct, and are not placing undue strain on the elbow.

Until symptoms of pain and inflammation subside, activities requiring repetitive wrist and forearm motion should be avoided. Once pain decreases to the point that return to activity can begin, the playing of sports, such as tennis, for long periods should not occur until excellent condition returns.

Many times, choosing a different size or type of tennis racquet may help. Frequent rest periods are important despite what the wrist and forearm activity may be. Compliance with a stretching and strengthening program is very important in helping prevent recurring symptoms and exacerbation.

Tennis Elbow in Adolescents

Tennis elbow is a condition in which tendon fibers that attach on epicondyle on the elbow’s exterior degenerates. The tendons talked about here anchor the muscles that help wrist and hand to lift.

Although the condition occurs mostly in patients of thirty to fifty years of age but it can happen to people of any age. Also tennis elbow affects almost fifty percent of teenagers who are in racquet sports thus the name “tennis elbow”.

But still most of the patients who suffer with tennis elbow are people who don’t play racquet sports. Majority if the times there isn’t any specific injury before the symptoms start showing up.

Tennis elbow can also happen to people who use their forearm muscles frequently and vigorously for day to day work and recreational activities. Ironically some patients develop the condition without any of the activity related reasons that leads to the symptoms.

The symptoms of tennis elbow include severe burning pain on the elbow’s exterior region. In majority of the cases this starts as a slow and mild pain gradually worsening with the passage of few weeks or sometimes months.

The pain worsens when one tries to lift objects. In some cases it may pain even while lifting light objects like a book or full coffee cup. In the severest cases it can pain even at the movement of the elbow.

The diagnosis of the tennis elbow involves physician enquiring about the medical history of the teenager and a physical examination of the elbow by pressing directly on the part where bone is prominent on the elbow’s exterior to check if it causes any pain.

The physician may also ask the teenager to lift the fingers or wrist and apply pressure to check if it causes any pain again. X-rays are never opted for diagnosis. However a MRI scan may be done to see changes in tendons at the attachment to the bone.

There are many treatment options available and in majority of the cases non-surgical treatment is given a try. The ultimate goal of the 1st phase of the treatment is pain relief. Be ready to hear from the physician to stop any activity leading to the symptoms.

The doctor may also tell the teenager to apply ice to elbow’s exterior and he/she may also tell the teenager to take anti-inflammatory medicines for relief from pain.

The symptoms also diminished with the help of orthotics. The physician may also want to go for counterforce braces and also wrist splints which can greatly cut down symptoms by providing rest to tendons and muscles.

The symptoms should show signs of recovery within 4 to 6 weeks otherwise next option would be to go for a injection called corticosteroid in the vicinity of the elbow. This greatly reduces pain and is also very safe to use. There are many side affects involved if it is overused.

Once there is a relief from pain the treatment’s next phase starts which involve modification of activities in order to prevent the symptoms from returning. The doctor may also prescribe the teenager to go for physical therapy which may include stretching exercises to gradually increase the strength of the affected tendons and muscles.

Physical therapies have high success rates and return your elbow back to normal working again. Again non-surgical procedures are highly successful in eighty five to ninety percent patients.

Surgical procedure is considered only when patients undergo relentless pain that doesn’t improve even after 6 months of non-surgical treatment. The procedure involves removal of affected tendon tissue and attaching it back to bone. The surgery is done on outpatient basis and does not need stay at the hospital.

The surgery is done by making a small incision on elbow’s exterior’s bony prominence. In recent years a surgery known as arthroscopic surgery has also been developed but no major benefits have been seen using it over the traditional method of open incision.

Tennis elbow therapy, is completely dependent on the severity of the injury.

Initially you should start treating tennis elbow by stopping the activity that caused it in the first place.

The sooner that happens the quicker will be the recovery, and the initial measures apart from the rest should be ice, heat, and compression. This combination works extremely well as ice controls swelling, and heat promotes blood flow thus speeding up healing, and it also relieves the tightness and the pain.

Cold compression therapy has no clinical research to back it up, but in combination with ibuprofen which is an anti inflammatory pain killer it seems to work well.

It is a good idea to wear a tennis elbow strap just below the elbow, this seems to reduce stress on the tendon damage, as it will reduce movement in the elbow.

Having rested from tennis until all the pain has gone, you now need to work on strengthening your forearm, and you do this as follows.

Always with the elbow supported, hold a weight that fits into your hand easily, weighing between one and two Kilos. Raise and lower the wrist with your palm facing upwards, and then again with the palm facing downwards. Stop whenever you feel pain, and that is very important. The weight should be gradually increased.

The next thing is to seek help from a physiotherapist who will work on the inflammation of the tendon with ultrasound, and retrain the extensor muscles.

If nothing seems to be working, then a steroid injection into the joint will seem to cure your tennis elbow for several months, but be warned it is extremely painful, there is a risk of localised infection, even rupture of the tendon, and you may be free of tennis elbow pain for several months, but there is a risk it will come back. Be aware that you can only have two steroid injections.

Finally if all else fails, and this is a last resort, then surgery may be necessary.

If your tennis is social, then this is somewhat extreme.

To summarise, tennis elbow is very painful, but rest, physiotherapy and anti inflammatory drugs will normally cure the problem. When you return to playing an elbow brace is a sensible precaution

What are Muscle disorders?
Movement disorders are a group of diseases and syndromes affecting the ability to produce and control movement. Though it seems simple and effortless, normal movement in fact requires an astonishingly complex system of control.

Disruption of any portion of this system can cause a person to produce movements that are too weak, too forceful, too uncoordinated, or too poorly controlled for the task at hand. Unwanted movements may occur at rest.

Intentional movement may become impossible. Such conditions are called movement disorders.


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