Understanding Tennis Elbow: Symptoms, Causes, and Effective Treatment Methods

Understanding Tennis Elbow: Symptoms, Causes, and Effective Treatment Methods

Tennis Elbow – Overview

Tennis elbow or Lateral epicondylitis, is a painful condition of the elbow. It is one of the most common disorders in sports. The basic aetiology for this condition is a sudden and repeated use of forearm extensor muscles. Tennis elbow is type of Tendinitis – swelling of the tendons, that causes or trigger a pain in the elbow and the arm.

Tennis elbow is one of the most common injuries at the age of 40. It is somewhat a misnomer, as one can get tennis elbow even if the person has never played tennis or any racquet sports. Surprisingly, only 5% of the total registered cases of tennis elbow are caused due to playing tennis.

Tennis Elbow: Symptoms 

The early and most common symptoms of tennis elbow is a mild and occasional pain on the outside of the elbow. Over time, from few weeks to few months, the mild and occasional pain turns into the constant and severe pain.

Tennis elbow may cause the most pain in the following circumstances:

1. While playing racquet sports.
2. While lifting something.
3. While opening a door or shaking hand.
4. While raising your hand or straightening your wrist.
5. While holding a coffee cup.

Tennis Elbow: Tests

Still confused if you have Tennis Elbow or Golfer Elbow? Here are a few tests that may help you to determine if you have Tennis Elbow or a Golfer Elbow

Golfer Elbow: The early and most common symptoms of Golfers elbow is a mild and occasional pain on the inner side of the elbow.

Tennis Elbow: The early most common symptoms of tennis elbow is a mild and occasional pain on the outer side of the elbow.

Now, it seems like you have tennis elbow as you are experiencing pain on the external side of your elbow. Here are a few simple tests that can confirm if it’s really tennis elbow.

1.Mills Test

1. Patient is seated in a comfortable position.
2. Patient will straighten the affected arm.
3. The doctor will fully pronate forearms inwards and flex your wrist to bend it forward.
4. Doctor will extend the elbow while examining Tennis Elbow.
5. Click here for video instruction

2.Cozens Test

1.Patient is seated in a comfortable position.
2.Extend your affected arm in front of you and make a fist.
3.Rotate your forearm inward and bend your wrist upwards.
4.Doctor will extend the wrist while patient gives resistance.
5.The doctor will examine Tennis Elbow while resisting the movement of your wrist.
6.Click here for video instruction

3.Maudsley’s Test

1.Patient is seated in a comfortable position.
2.Extend your affected arm in front of you and pronate inwards.
3.The doctor will resist the extension of the middle finger of the affected hand.
4.The doctor will examine Tennis Elbow while resisting the movement of your middle finger.
5.Click here for video instruction

4.Other Tests 

The coffee cup test

1. Patient is seated in a comfortable position.
2. Place a cup of coffee on the table.
3. While picking up the coffee of cup, you may experience occasional and mild pain.
4. Simply rate your level of pain while grasping a cup of coffee or a carton milk.
5. If you feel pain outer side of your tennis elbow, it may be Tennis Elbow.

2.Wrist Resistance Test

1. Patient is seated in a comfortable position.
2. Extend your affected arm in front of you with your palm facing down.
3. Place your opposite hand on the back of your extended hand.
4. Press your top hand on your bottom hand and attempt to bend the bottom wrist backward.
5. Create resistance by pressing the top hand against the bottom one.
6.If you feel pain on the outer side of your elbow, it may be Tennis Elbow.

3.Middle Finger Resistance Test

1. Patient is seated in a comfortable position.
2. Extend your affected arm in front of you with your palm facing downward.
3. Use your opposite hand to pull your middle finger back towards your forearm.
4. At the same time, use your middle finger to resist this movement.
5. Next, turn your palm to face upwards and repeat the same action again.
6. If you feel pain outer side of your tennis elbow, it may be Tennis Elbow.

4.Chair Pickup Test

1. Patient is seated (or made to stand) in a comfortable position.
2. You will need a light chair with a high back for this test.
3. Extend your affected arm in front of you.
4. Bend your wrist so your fingers face downward.
5. Use your thumb, first finger and middle finger to grasp the back of the chair and lift it. Keep your arms straight as you rise the chair.
6. If you feel pain on the outer side of your elbow, it may be Tennis Elbow.

Tennis elbow:  Cause 

Tennis elbow usually develops over the period of time. Any occupation, sports or domestic activity that demands the repetitive use of forearm extensor (like a racquet swing), can strain the muscles and put too much stress on the tendons. It can eventually cause microscopic tears in the tissues and trigger a pain at outside of the forearm, which is commonly known as tennis elbow pain.

Wrong technique, holding the racquet too tight or too lose, can put more stress on the tendons and can cause tennis elbow in longer run.

Here are a few Sports / Activity that might cause tennis elbow
1. Tennis
2. Squash
3. Badminton
4. Throwing sports – such as Javelin
5. Manual work – such as plumbing, using hammer, suing screw drivers, carpentry
6. Fencing
7. Painting
8. Playing musical instrument

Tennis elbow: Treatment 

There are two types of treatment available 1. Non-Surgical and 2. Surgical

Tennis elbow is self-limiting condition. This means it will eventually get better without treatment. However, there are certain treatment that can be used to improve your condition and speed up your recovery. Here are a few of them:

Non-Surgical Treatment

1. Rest- Rest is the first step towards recovery. It’s important that a person takes rest for the injured arm and stops doing the activity that is causing the problem.
2. Icing the Elbow –  Experts recommend doing it for 20 to 30 min every 2 to 3 days or until the pain is gone. Right after the activity, ice should be applied to reduce pain and swelling.
3. Technique and Equipment – It is recommended to modify the technique or activity if it is one of the primary sources of tennis elbow. Modifying the optimal weight of the equipment may help in reducing the tennis elbow pain and optimal recovery.
4. Using elbow strap – Using a brace cantered over the back of your forearm may help relieve pain of tennis elbow. The elbow strap or brace can help reduce load by resting the affected muscles and tendons.
5. Physical Therapy – Physical therapy is recommended such as massage, ultra sound, cold laser to the affected area to reduce the pain and stiffness. Doctor may help you with specific exercises like, Wrist extensor stretch, Wrist flexor stretch, extensor strengthening, wrist rotation, strengthening the upper forearm, and improving range of motion.
6. Shockwave Therapy – Shock wave therapy sends sounds waves to the affected area of the elbow. These sound waves create “micro trauma” that promote the body’s natural healing mechanisms.
7. Steroids and NSAIDs – Steroids, such as cortisones, are very effective anti- inflammatory medicine. They are used to treat particular painful musculoskeletal problems. Some people with tennis elbow may be offered steroid injections when other treatment modalities haven’t worked. Steroid injections are only likely to provide short term relief and their long-term effectiveness has been poor. Please consult your doctor before taking any medicine and injection.
8. Performing range of motion exercises – It is recommended to perform a range of motion exercises to reduce stiffness and increase flexibility. Your doctor may recommend few exercises that need to be performed 3 to 4 times a week.

Surgical Treatment – If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, your doctors may recommend surgery. Please consult your doctor before taking any action. Here are few examples of surgical Treatment. 1.Open surgery 2.Arthroscopic surgery

Tennis Elbow: Prevention 

Here are a few tips that may help you prevent tennis elbow.

1. Take brakes – It is recommended to take a break at equal intervals. You should avoid repetitive tasks. If you feel any soreness in your hand or mild pain at elbow, you should take break and use ice to reduce inflammation and ease the pain.
2. Proper use of equipment – Using the Right size and weight of equipment may help the player in preventing the tennis elbow. Consult local doctor or professional coach for better understanding.
3. Proper Warm up and cool down – A proper warm up and stretching of fingers, wrist, forearm and shoulder muscles before each session is recommended. At the end of the session you should do proper cool down followed by icing on the elbow and shoulders.
4. Proper Technique – Most of the time it is bad technical habits that may cause the tennis elbow. It is recommended to get in touch with local coach and work on the biomechanics of tennis to prevent future tennis elbow injury.
5. Listen to your body – If it hurts while you are playing, you should stop playing immediately. Rest and use anti-inflammatories. Return to play when the pain subsides. See doctor if the pain persists and before starting an exercise regimen.
6. Check your pain scale – Using a pain scale of 1-10 – with 10 begin the highest level of pain, if you are at a 5 or more, you should stop the activity immediately. Consult your doctor immediately for further assistance.

Note: Always consult a doctor before attempting any exercises for tennis elbow. A doctor can make sure that exercise will not affect any underlying conditions or injuries.

Tennis Elbow: Post-Treatment, Ready to Play ?

The most important question that arises is, when can I rejoin sports after the tennis elbow treatment?

It totally depends on the extent of the damage to the tendon. Every person is unique and different. Everyone has a different way and different speed of healing and recovery. Doctors may help in finding out your healing rate. Please consult your doctor or coach before joining sports.

Whatever you do, but don’t rush the recovery. If you start pushing yourself before your tennis elbow is healed, you can make the damage worse. Listen to your body and consult your coach and doctor. If everything is under control, you are ready to return to your activity.

Reference
https://www.webmd.com/fitness-exercise/tennis-elbow-lateral-epicondylitis#1-2https://www.nhs.uk/conditions/tennis-elbow/https://orthoinfo.aaos.org/en/diseases–conditions/tennis-elbow-lateral-epicondylitis/https://www.nhs.uk/conditions/tennis-elbow/treatment/https://www.gwh.nhs.uk/media/186178/tennis-elbow-exercises.pdf