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Physiotherapy In Action: Tennis Elbow

by: - October 4, 2016
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Dr Lucia Corriette

Dr Lucia Corriette

By: Dr Lucia Corriette

Overview of Tennis Elbow

Tennis elbow or lateral epicondylitis is a condition that affects the elbow joint. It is an inflammation of the tendons of the forearm muscles on the outside of the elbow. Tennis elbow is usually painful and associated with overuse or repetitive actions.

tennis-elbow

Causes

As the name implies it can be caused by playing tennis or other racquet sports, but other sports can also be a cause. Only about 5-10% of tennis elbow cases are due to playing tennis. Overuse or performing the same action repeatedly during sport causes damage to the tendons that attach to the outside of the elbow. Poor technique and lack of adequate or proper equipment could also put players at greater risk of developing tennis elbow.

Painters, plumbers, carpenters, auto workers, cooks, and even butchers are more likely to get tennis elbow. Again the repetition and the weight lifting that is part of these occupations is the cause.

People diagnosed with tennis elbow are usually aged 30 to 50.

Signs and Symptoms
• Elbow pain without any appreciable cause
• Weak grip
• Pain may increase when holding a racquet, turning a key/door knob or carrying a heavy object

Medical Evaluation
Tennis elbow is usually diagnosed from the clinical evaluation. However, x-rays may be ordered to rule out conditions such as arthritis.
Electromyography or nerve conduction tests may be ordered to rule out nerve compression. This is because the symptoms of nerve compression may mimic those of tennis elbow.

Conservative or Non-Surgical Treatment

Rest: You may be advised to stop taking part in sports or heavy work activities for several weeks.

Medication: Non-steroidal anti-inflammatory drugs like ibuprofen or diclofenac may be prescribed to help decrease pain and swelling. Your doctor may suggest a steroid injection into the elbow to help with pain relief.

Review of equipment: Those who play racquet sports may be advised on proper equipment. Stiffer racquets and looser-strung racquets can help decrease the stress on the forearm, and so reduce the amount of work needed from the forearm muscles. Changing an oversized racquet to a smaller head may help prevent a repeat of the elbow pain.

Bracing: Use of a brace on your forearm may help decrease the pain associated with tennis elbow. The brace helps to rest the affected muscles and tendons by reducing their workload.

bracing

Physiotherapy
• Ultrasound, ice massage, or electrotherapeutic techniques may be used to help reduce pain and to improve muscle healing.

Ultrasound of the elbow

Ultrasound of the elbow

Electrical stimulation of the elbow

Electrical stimulation of the elbow

Strengthening exercises help to improve grip strength.

Strengthening exercises help to improve grip strength.

Surgical Management
Surgery may be recommended if there is no improvement after 6 to 12 months of nonsurgical treatments. Surgery may be arthroscopic (through the use of miniature instruments and small incisions) or open, in which case there would be an incision over the elbow. Usually, these are both same day procedures, meaning that you are not required to spend the night at the hospital. The purpose of surgery is to remove the damaged part of the muscle and reattach healthy muscle back to bone. 80-90% of surgical procedures are successful.

elbow-surgery

Following surgery your elbow may be placed in a splint. When the splint and sutures (stitches) are removed, you may be referred to physiotherapy for rehabilitation. Exercises are initially light and progress gradually over several weeks.

Ultimately, tennis elbow is a manageable condition that can be successfully treated without surgical intervention if diagnosed early and treated appropriately.

References
Balance in Life. Electrotherapy. http://www.balanceinlifepc.com/electrotherapy.htm
Chang, HC. Elbow Pain – Is It Tennis Elbow? http://ortho.com.sg/main/is-your-elbow-pain-tennis-elbow/
Shockblocker. Tennis elbow bands – do they work? http://www.theshockblocker.com/tennis-elbow-bands-work/
VfitPhysio. Tennis / Golfers Elbow. http://www.vfitphysio.co.uk/tennis-golfers-elbow/
American Academy of Orthopedic Surgeons. Tennis Elbow (Lateral Epicondylitis). http://orthoinfo.aaos.org/topic.cfm?topic=A00068
Flatt AE. Tennis elbow. Proceedings (Baylor University Medical Center). 2008;21(4):400-402.

Cohen M, da Rocha Motta Filho G. Lateral epicondylitis of the elbow. Revista Brasileira de Ortopedia. 2012;47(4):414-420. doi:10.1016/S2255-4971(15)30121-X.