Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow: painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.
Anatomy
Tennis elbow causes pain that starts on the outside bump of the elbow.
The forearm muscles that bend the wrist back are attached and connected by a single tendon. Tendons connect muscles to bone.
Tendons have high tensile strength. This means they can withstand high forces that pull on both ends of the tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move. The constant pull on these muscles and tendons causes general wear and tear.
Causes
Why did I develop tennis elbow?
- Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.
- In an acute injury, the body undergoes an inflammatory response. Special inflammatory cells make their way to the injured tissues to help them heal. Conditions that involve inflammation are indicated by -itis on the end of the word. For example, inflammation in a tendon is called tendonitis. Inflammation around the lateral epicondyle is called lateral epicondylitis.
- Tennis elbow often does not involve inflammation. Rather, the problem is within the cells of the tendon. Doctors call this condition tendinopathy. In tendinopathy, wear and tear is thought to lead to tissue degeneration. The collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.
Symptoms
What does tennis elbow feel like?
- Tenderness and pain that starts on the outside of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers.
- The forearm muscles may also feel tight and sore. The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow.
- Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won’t straighten out completely.
Diagnosis
How can my doctor be sure I have tennis elbow?
At the Centre for Musculoskeletal Medicine we will first take a detailed medical history.
You will need to answer questions about your pain, how your pain affects you, your regular activities, and past injuries to your elbow. Following this a thorough physical exam will take place
You may need to get X-rays of your elbow. The X-rays mostly help your doctor rule out other problems with the elbow joint. If the diagnosis is not clear, your doctor may order other special tests such as an MRI.
Treatment
What can I do to make my pain go away?
The key to treatment is to keep the collagen from breaking down further. The goal is to help the tendon heal.
- Dry needle By poking holes in the tendon breaks up scar tissue and gets the tendon to bleed. Bleeding in the tendon helps stimulate the healing response.
- Soft tissue & joint mobilisation
- Ultrasound & Acupuncture
To help stimulate tendon healing. - Shock wave therapy
Newer form of treatment. It uses a machine to generate shock wave pulses to the sore area. Patients generally receive the treatment once each week for up to three weeks. It is not known exactly why it works for tennis elbow, but recent studies indicate that this form of treatment can help ease pain, while improving range of motion and function. - Cortisone injection
- Plasma Rich Platelets. Platelets contain granules, which contain growth factors to stimulate healing of the tendon.
- Clinical Pilates
- Prolotherapy injections help stimulate healing of the tendon, ligament or joint of the elbow
- Occupational advice How to rest your elbow and how to do your activities without putting extra strain on your elbow.
