Introduction
Tennis elbow or lateral (outer) epicondylitis is an overuse injury to the forearm muscle tendons (rope-like structures that attach muscles to bone).
Symptoms
The tendon of the extensor carpi radialis brevis (ECRB) muscle is most commonly affected. It is located at the outer elbow near to the bony prominence. The pain may radiate upwards along the upper arm and down to the forearm. You may experience pain and weakness while gripping or carrying objects with their elbow extended.
Common Causes
The most common cause appears to be excessive repetitive motions of the wrist. Some examples of activities involving such motions could be:
- Heavy lifting
- Typing
- Painting or writing
Risk Factors
Tennis elbow happens equally in both sexes and most often affects people between the age of 30-50 years. Other risk factors for tennis elbow are:
- Handling tools heavier than 1kg
- Handling tools heavier than 20kg at least 10 times a day
- Repetitive movements for periods longer than 2 hours per day (Rijn et al. 2009)
Commonly, occupational hazards are associated with tennis elbow. These include jobs like:
- Office workers
- Electricians
- Gardeners
- Carpenters
- Housewives
- Tennis athletes (>2 hours daily)
Conservative Treatment
Some typical strategies to manage tennis elbow and its symptoms are:
- Sufficient rest and avoiding painful activities
- Applying ice
- Bracing of the elbow
- Non-steroid anti-inflammatory drugs (NSAIDs)
- Corticosteroid injection
- Extracorporeal shock wave therapy
- Equipment check / modification of the playing techniques.
For the majority, symptoms may even resolve without treatment within 6-12 months.
Early relief of pain helps in accelerating the healing process. However, motivation to follow the therapeutic exercise program is the most crucial part of rehabilitation (Vicenzino 2003).
Physiotherapy and Rehabilitation
Recovery goals
- Reduce pain and control inflammation with ultrasound therapy and deep tissue massage
- Mobilisation with movement – significant improvement in pain-free gripping strength (Abbott et al. 2001)
- Strengthen the muscles around the elbow and wrist
- Education and lifestyle modification to avoid aggravating activities
- Shockwave therapy
Surgical Intervention
If conservative measures are not effective, arthroscopic surgery can be considered. Research has found significant improvement in pain and functional recovery up to 3 months after operation (Oki et al. 2014).
Elbow manipulation and exercises have been shown to bring about more long term benefit than no treatment.
