What is Lateral Epicondylitis (Tennis Elbow)?
Tennis elbow is a term for pain on the outside of the elbow that is typically aggravated by gripping or lifting when the palm is facing downwards. One of the most common diagnoses for tennis elbow is tendinopathy of the common extensor tendons of the wrist, which is typically an overuse injury. The muscles that bend the wrist backwards connect via a tendon that attaches just above the elbow, at the bone on the outside of the elbow. This tendon can become painful and inflamed after activities such as gripping, lifting, typing and repetitive activities that involve repetitive use of the lower arm and hand. Tennis elbow is the most common reason that people seek treatment for elbow pain. Many people find that their symptoms continue for months to years if not assessed and treated early.
Signs and Symptoms of lateral epicondylitis (Tennis Elbow)
- Pain on the outside of the elbow that can extend down the forearm and sometimes into the hand. This pain may be more prominent during activity but can also develop into an ache even at rest.
- Pain aggravated by gripping or lifting with the palm turned downwards. In more chronic cases, the elbow may become stiff after periods of rest, such as first thing in the morning.
- Occasionally there may be some swelling around the area of the bony prominence on the outside of the elbow.
- Tenderness on the bony point of the elbow and into the belly of the muscle of the outside of the forearm
Other conditions, such as elbow joint arthritis and radial nerve entrapment, can give symptoms similar to tennis elbow, and your physiotherapist can assess whether this is the case. There are also times when your neck may be the source of your tennis elbow.
What causes Lateral epicondylitis (Tennis elbow)?
Tennis elbow is typically caused by an increase in activities that load the tendon. It happens over a period of time. Examples of repetitive activities are gripping, typing, tennis, raking, painting and even knitting . The tendon responds to this increase in activity by becoming swollen and begins a process of trying to make itself stronger so that it can perform the task in the future. However, this process does not always work perfectly and, in some people, the tendon gradually becomes painful, often days after the increase in loading. If left untreated, this pain and dysfunction can become more debilitating.
Treatment for lateral epicondylitis (Tennis elbow)
Accurate diagnosis is crucial in the selection of the best treatment for tennis elbow. Your physiotherapist will be able to accurately assess and differentiate the source of your elbow pain. Once your physiotherapist has established the source of your pain, they will discuss the best management of your condition and a plan to return you to being pain-free.
Part of your physiotherapy management may include:
- Hands-on treatment. This will address any imbalances in muscle or tendon which can be a common contributing factor to this condition
- Activity modification. An initial change to your exercise regime or daily activities may be needed to avoid the condition getting worse
- Ice. to ease pain and swelling. Do it for 20-30 minutes every 3 to 4 hours for 2 to 3 days, or until the pain is gone.
- Anti-inflammatory. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling as per GP instructions.
- Strengthening exercises. This may be with weights or resistance bands which will help relieve the pain, increase the ability of the tendon to cope with load and increase the strength of your forearm muscles. This will be something that your physiotherapist will progress as you get stronger. You will probably need to do this for 12 weeks.
- Taping/bracing. Your physiotherapist may fit you with an elbow brace or use strapping to relieve the pain in the short term, but this will not be the solution to your problem and is not a substitute for exercise.
In the past cortisone injection therapy was often recommended, however new research has indicated that corticosteroid injections result in worse long-term outcomes compared to physiotherapy or placebo injections.