Lateral epicondylitis, or tennis elbow, is a medical condition involving inflammation or micro-tearing of the tendons that connect the forearm muscles to the bony bump at the outside of the elbow.
Tennis elbow is an overuse injury caused by the repetitive movement and contraction of the forearm muscles, especially in a backhand stroke when played with poor technique. While it is most common in racquet sports such as tennis, badminton, and squash, it can also occur in other sports, viz., swimming, golfing, or weightlifting, and among certain occupations like painters, mechanics, carpenters, plumbers, butchers, and chefs. Prolonged use of computers and typewriters can also lead to the development of tennis elbow.
What causes a tennis elbow?
A tendon is the part of a muscle that attaches to the bone. Forearm tendons attach the forearm muscles to the bony prominence at the outside of the elbow. Tennis elbow typically occurs when a specific muscle in the forearm — the extensor carpi radialis brevis (ECRB) — is damaged. The ECRB helps raise (extend) the wrist.
Repetitive and prolonged stress weakens the ECRB muscle, causing micro-tears in the muscle’s tendon at the point where it attaches to the bone at the elbow. These tears lead to inflammation and pain. One can experience this pain when straightening or fully extending the arm.
Symptoms
Typical symptoms of tennis elbow include pain and burning on the outside of the elbow and weak grip strength. Symptoms develop over time and may gradually worsen over weeks or months.
Pain of the tennis elbow can sometimes travel into the forearm and wrist.
Accompanied by weakness, this pain in the arm muscles can restrict movement, making it difficult to:
- shake hands
- squeeze or grip an object such as a racquet, a plumbing or a painting tool
- drive screws or turn a doorknob
- cut or chop up foods, particularly meat
- hold a tea or coffee mug
- use a computer mouse for a long time
- drive
- lift even lighter weights
Risk factors
Factors that can increase the risk of tennis elbow include:
- Age. Although tennis elbow affects people of all ages, it is most common in adults between 30-60.
- Work. People in occupations involving repetitive twisting of the wrist and arm, such as plumbers, painters, carpenters, butchers, and cooks, are more likely to develop tennis elbow.
- Certain sports. Playing racquet sports increases the risk of tennis elbow. Not having good form or using poor equipment increases the risk further. Playing more than two hours a day also makes you prone.
- Other factors. Smoking, being obese and certain medicines can put you at risk.
Treatment
Conservative non-surgical treatments include:
- rest
- icing
- use of nonsteroidal anti-inflammatory drugs (such as Advil or Aleve)
- ultrasound
- bracing and compression to reduce the stress on the elbow joint
- mild exercises to strengthen the forearm muscles
- performing the utmost range of movement of the affected muscles and the joint, even if in pain, to help prevent disuse atrophy and formation of scar tissue
- steroid shots into the affected tendon if the measures mentioned above are ineffective
If symptoms do not improve after 6 to 12 months of other treatments, surgery to remove damaged tissue may be an option. The surgery can be open, involving a single large cut (incision), or arthroscopic through several smaller openings.
Rehabilitation
Whatever the medical treatment, rehabilitation to rebuild strength and regain the use of the elbow are vital to recovery.
It is important to gradually start moving and putting some load on the affected tendon to heal it. However, this might cause some discomfort initially, which is perfectly normal. The affected tendons need to be capable of doing three things:
- absorb force,
- stay in one position under tension (to be able to hold), and
- transmit force.
Exercises for tennis elbow
I am listing a couple of exercises to help improve the strength, flexibility, and endurance of the affected muscles and tendons:
1. Fist clench: Poor grip strength is a common symptom of tennis elbow. Improving grip by building your forearm muscles can help improve your ability to perform daily activities.
Sit at a table with your palm up and forearm resting on the table. Hold a rolled-up towel or small ball in your hand, squeeze the towel, hold for 10 seconds and release. Repeat at least ten times.
2. Supination: The Supinator, the large muscle on your forearm that attaches to the elbow, is responsible for turning your palm up. It is involved in movements that can cause tennis elbow.
With your elbow fixed on a table or your knee, rotate your arm outward, turning your palm up, hold for about 30 seconds, and then rotate your hand back in the other direction until your palm is facing down. Repeat 20 times on each side.
3. Wrist extension: The wrist extensors are a group of muscles responsible for bending your wrist, as when making the hand signal for stop. These small muscles also connect to your elbow and are often subject to overuse during racket sports.
With your elbow comfortably fixed on a table or your knee with your palm facing down, extend your wrist as if gesturing for someone to stop. Return to the starting position and repeat ten times. Try to isolate the movement to your wrist, keeping the rest of your arm still.
4. Wrist flexion: The wrist flexors are a group of muscles that work opposite the wrist extensors. Subject to overuse, they contribute to pain and inflammation as well.
Rest your elbow comfortably on your knee while sitting on a chair. With your palm facing up, flex your wrist by curling it towards your body. Return to the starting position and repeat ten times on each side.
5. Towel Twist: Since the movement involves the twin action of the common wrist flexor of one hand and extensor muscles of the other, it helps strengthen them together.
Sitting in a chair with shoulders relaxed, hold a towel and twist it with both hands in opposite directions as if you are wringing out water. Repeat ten times, then repeat another ten times in the other direction.
Exercise Caution!!
Dr Renu Madan 