What is it?
Lateral Epicondylitis or more commonly known as “Tennis Elbow” is the most common cause of pain in the elbow. It is a tendinopathy which involves the extensor muscles of the forearm which originate from the lateral side of the arm.
Interestingly, only 5% of people affected with “tennis elbow” relate the injury directly to tennis. It is more commonly caused by overuse or work-related activities involving a lot of gripping than playing tennis. People with repetitive one-sided movement in their jobs such as electricians, carpenters and gardeners are all at higher risk of developing “tennis elbow”.
Patients typically present with lateral elbow pain which is reproduced by palpation to the extensor muscles origin from the bony part on the outside of the elbow. Pain can occasionally radiate upwards along the upper arm and downwards along the outside of the forearm and in rare cases even to the third and fourth fingers. Additionally, there may be weakness in the muscles around the forearm and wrist resulting in difficulty with simple tasks such as gripping and turning objects including; opening a door, turning on/off a tap and shaking someone’s hand. Symptoms can last on average between 2 weeks to 2 years.
– “Tennis elbow” affects 1-3% of the population with individuals between 35-50 years old most commonly affected.
– The injury is often work-related with individuals completing high levels of wrist extension, pronation or supination during manual work
– Handling tools heavier than 1kg, handling loads heavier than 20kg at least 10 times per day and repetitive movements for more than 2 hours per day.
– Other risk factors: Training errors and misalignments, flexibility issues, poor circulation, strength deficits or muscle imbalances (Van Rijin et al., 2009)
A thorough subjective assessment from a Physiotherapist encompassing the activity levels, occupational risk factors as well as an in depth physical assessment will determine the likelihood of “tennis elbow”.
Investigations are usually not performed for straightforward cases of lateral elbow pain, however, ultrasound examination can be useful in determining the degree of tendon damage as well as the presence of a bursa.
– X-rays: May be taken to rule out arthritis of the elbow
– Magnetic Resonance Imaging (MRI): if symptoms are perceived to be related to a neck problem
– Electromyography (EMG): Can be useful in ruling out nerve compression
Non-operative medical management will typically aim to relieve pain and symptoms and to control any inflammation present. Once this has occurred a strengthening program will be guided by your Physiotherapist gradually increasing load to enable you to return to sport or activities of your desire.
If there is onset of pain after an injury or provocative task, then applying the P.O.L.I.C.E protocol within the first 72 hours is important.
Protection– Wearing a specialised elbow brace or support can help reduce strain on the tendon
Optimal Loading– Only completing tasks/activities that are pain-free. Gentle motion should be started as soon as tolerated
Ice– Applying ice may help with the swelling around your injured site as well as decrease some of the acute pain that you may have. 15 minutes every 2 hours is the advised duration
Compression– Apply a bandage to the area to help compress the injury and maintain swelling.
Elevation– Elevate your entire arm on a pillow where able
Physiotherapy treatments may include massage, electrotherapy, acupuncture, bracing and taping followed by a strengthening to regain strength and range of movement.
Other treatments can include ultrasound, corticosteroid injection, nitric oxide donor therapy, Botox injections and platelet-rich plasma injection’s which all have confounding research to support their use.
In severe cases, surgery is the last line treatment only considered in individuals who have had the condition for more than 6 months and have attempted other treatments with no success.
Overall, 90-95% of patients with “tennis elbow” will improve and recover with treatment listed above. 89% of patients will recover within 1 year without any treatment except perhaps avoidance of the painful movements (Wright, 2008).
Blog by Ryan Fuller (Physiotherapist)