Tennis Elbow

Do you have elbow or forearm pain that gets worse when you try to hold things? Maybe you have recently picked up a new hobby or job that requires you to use your hands a bit more? For example, using a hammer all day or typing on a keyboard for long hours without a break are both repetitive movements, and if it is something your muscles and tendons aren’t regularly doing then you may have overworked them.

Diagnosis/Description:

Tennis elbow or “lateral epicondylalgia/epicondylitis” is commonly caused by repetitive movements or overuse of the muscles and tendons in the elbow.

Gold standard for diagnosis:

• Point tenderness at the lateral epicondyle is nearly consistent
• Tenderness of the epicondylar muscle bodies just distal to this point is frequent
• Pain with wrist extension against resistance
• Absence of pain during maneuvers that load the ECRB + absence of US/MRI abnormalities suggest diagnosis other than tennis elbow.

 

 

 

 

 

 

 

 

Symptoms/barriers

Here are some common symptoms that are associated with this issue:

1. Pain from the outside of your elbow and down the back of your forearm
2. Pain or weakness when holding or squeezing objects
3. Pain or weakness when bending your wrist

Relevant anatomy:

There are 4 muscles that attach to the lateral epicondyle of the humerus. Most studies suggest that the tendon lesions and beginning of tennis elbow originate from the Extensor Carpi Radialis Brevis (ECRB). This is because the tendon has to tolerate greater loads than the other tendons.

Why it is generally the extensor carpi radialis brevis (ECRB)

• ECRB is in direct contact with humeroradial joint line (joint loads transferred directly to ECRB)
• At this site, ECRB is tendinous whereas others are muscular = less able to heal after injury
• Greater fragility due to the tendon footprint on the epicondyle being 13 times smaller than ECRL
• Friction on deep surface of ECRB and capitellum during F/E

Severity (grades):

Stage 1. Recent; transient inflammation

Stage 2. Angiofibroblastic hyperplasia characterised by high cell counts, blood vessel hyperplasia, and collagen fibre breakdown

Stage 3. Lesions may progress to partial- or full-thickness tendon tears

Stage 4. Fibrosis and calcification

Demographic/Prevalence:

• 1-3% of adults each year
• 10-50% of tennis players
• Workers who repeatedly exert excessive exertion for an extended period risk developing tennis elbow.

Prognosis:

• Spontaneous recovery without treatment within 1-2 years
• After 1 year = Physiotherapy has slightly better results than no treatment (Smidt et al. Randomised 185 pts to corticosteroid, physio, or no treatment)

Treatment:

• Physio is the first line of treatment with the below modalities being some techniques your Physio may try. 
  • Eccentric exercises
  • Mobilisations
  • Deep friction manual therapy
  • Education
  • Dry Needling

Ref:

Management of Lateral Epicondylitis (Orthopaedic & Traumatology: Surgery and Research)

The 100 most cited articles in lateral epicondylitis research: a bibliometric analysis (Frontiers in Surgery)

 

 

Written by

 

Kalani McKenzie Tonga
Physiotherapist

PhysioMotion Cairns
Shop 5/9-11 Stokes Street
Edmonton QLD 4869