Tennis elbow
Tennis Elbow is a condition when the outer part of the elbow becomes painful and
tender, usually as a result of a specific strain, overuse, or a direct bang. Sometimes no
specific cause is found.
What causes tennis elbow
This injury is caused by repetitively twisting the wrist or forearm. The injury is
classically associated with tennis playing, hence the name "tennis elbow", but
any activity that involves repetitive twisting of the wrist (like using a screwdriver) can
lead to lateral epicondylitis.
The most common cause is over use of the muscles which are attached to the bone at this
part of the elbow. That is to say, the muscles which pull the hand backwards (the wrist
extensors). All the extensor muscles of the hand attach to the elbow at the outer part
(the lateral epicondyle). If they are strained or over used they become inflamed, which
means they are swollen, painful and tender to touch.
Sometimes the inflammation is caused by a direct injury or bang. Sometimes, especially
when the cause is direct injury or strain, the muscles are actually partially torn.
Symptoms of tennis elbow
- Elbow pain that gradually worsens
- Pain radiating from the outside of the elbow to the forearm and back of the hand when
grasping or twisting
- Weak grasp
Diagnosis of tennis elbow
Tennis Elbow is characterized by pain and tenderness on the outside part of the elbow.
This pain will worsen with any attempt to either play racquet sports or lift heavy objects
with the wrist and hand.
Elbow X-rays are done to evaluate the bone surrounding the muscles.
Rarely, an MRI may be ordered to rule out a large tendon tear.
MRIs of normal and partially torn tendons
Treatment of tennis elbow
Heat or ice is helpful in relieving tennis elbow pain. Once acute symptoms have
subsided, heat treatments are used to increase blood circulation and promote healing. The
physician may recommend physical therapy to apply diathermy or ultrasound to the inflamed
site. These are two common modalities used to increase the temperature of the tissues in
order to address both pain and inflammation. Occasionally, a tennis elbow splint or taping
may be useful to help decrease stress on the elbow throughout daily activities. Exercises
become very important to improve flexibility to all forearm muscles, and will aid in
decreasing muscle and tendon tightness that has been creating excessive pull at the common
attachment of the epicondyle.
The physician may also prescribe nonsteroidal anti-inflammatory drugs (NSAIDS) to
reduce inflammation and pain. Injections of cortisone or anesthetics are often used if
physical therapy is ineffective. Cortisone reduces inflammation, and anesthetics
temporarily relieve pain. Physicians are cautious regarding an excessive number of
injections as they have been found to weaken the tendon's integrity. In addition, a
significant number of patients experience a temporary increase in pain following
corticosteroid injections.
A newer method of treatment for tennis elbow is shock wave therapy, in which pulses of
high-pressure sound are directed at the injured part of the tendon. The "shock"
refers to the high pressure, which breaks down scar tissue and stimulates the regrowth of
blood vessels in healthy tissue. Shock wave therapy sessions take about 20 minutes and
have been reported to have a success rate of 80%. Shock wave therapy has very few side
effects; one group of German physicians found that temporary reddening of the skin or
small bruises were the most commonly reported side effects.
Botulinum toxin, or Botox, is also being tried as a treatment for tennis elbow as of
late 2003. Although further research needs to be done, Botox appears to relieve pain in
chronic tennis elbow by relaxing muscles that have gone into spasm from prolonged
inflammation.
Surgery
If conservative methods of treatment fail, surgical release of the tendon at the
epicondyle may be a necessary form of treatment. However, surgical intervention is
relatively rare. |
