Tennis Elbow – The Scourge of the Athlete

Tennis Elbow – The Scourge of the Athlete

Tennis elbow is also commonly known as “lateral epicondylitis” or “lateral elbow tendinopathy.” It is a condition that typically happens when you overuse your forearm muscles that result in pain over the outside of the elbow. It earned the term ‘tennis elbow’ as it was commonly associated with tennis players. ( Akin to the term ‘golfer’s elbow which typically describes pain over the inner side of the elbow ) The truth is, tennis elbow can affect anyone who subjects their forearm muscles to repeated extension-supination ( twisting outwards ) arcs of motion.

There are some tendons that join your forearm muscles to the outside of your elbow. Typically due to trauma, inflammation is provoked in these muscles, or micro-tearing of the tendons occurs, then you can feel severe pain and tiredness in your elbow. When you perform a similar motion repeatedly, the forearm muscles and tendons become repetitively damaged due to the overuse. As a result, you may develop severe pain in your elbow and this condition is known as Tennis Elbow.

Anatomy of Elbow

Three bones in your body make up the elbow joint. The upper arm bone is known as the humerus and there are two bones in your forearm known as radius and ulna. Epicondyles are the bony bumps present at the bottom of the humerus from where several muscles of your forearm begin their course. The bony bump, which is present on the lateral (outer) side of your elbow, is known as the lateral epicondyle.

There are several muscles, joints, and tendons that hold your elbow together. The lateral epicondyle is the source of origin for those muscles in your forearm that are responsible for the movement and extension of your wrist and fingers. The most involved tendon in the tennis elbow is known as Extensor Carpi Radialis Brevis (ECRB).

The typical patient affected by Tennis Elbow?

Almost 1% to 3% of the population may suffer from tennis elbow. 10% to 50% of the people suffering from tennis elbow is typically sportspersons or gym-goers. If you analyze reports from the past few years, however, you will find that only 5% of these diagnoses are related to playing tennis.

Many studies have shown that men are more vulnerable to tennis elbow in comparison to women. It usually affects people between the ages of 30 to 50, though anyone in any age group can get affected by tennis elbow.

Many athletes and workers who actively participate in the activities that require repetitive wrist, elbow, and arm movements will be more prone to Tennis elbow. Some of them may include:

• Golf Players
• Basket Ball Players
• Bowlers
• Baseball Players
• Garden and lawn workers
• People working in an assembly line
• Mechanics and carpenters, etc

Causes of Tennis Elbow

Some of the major causes of tennis elbow are discussed below:

Overuse

Several studies indicate that one of the major reasons behind the cause of tennis elbow is forearm muscle overuse. Due to this overuse, muscle insertion may degenerate and microscopic tears in the tendons result in progressive inflammation and the syndrome of ‘tennis elbow’.

Activities

It’s a common misconception that only athletes are affected by tennis elbow but that’s not the case. There are many people who participate in recreational and manual-work activities requiring vigorous and repetitive use of the forearm. They may also suffer from tennis elbow. A few of them include painters, plumbers, carpenters, and chefs. Even keyboard warriors may report tennis elbow symptoms from poor ergonomics and repetitive use of the forearm muscles!

Age

Most people who develop tennis elbow are between the ages of 30-50 years. Although tennis elbow can occur to anyone, people from this specific age group are more vulnerable to this injury because of subtle muscle degeneration already related to their age. The lack of rest, repetitive activities, and poor ergonomics will of course enhance the chances of developing tennis elbow.

Unknown

Tennis elbow can also occur without any prior injury or repetitive arm movements. Such occurrences are known as “idiopathic” or of an unknown cause.

What Are the Symptoms of Tennis Elbow?

The symptoms of tennis elbow do not appear at once. You will experience them gradually. You may start experiencing mild pain in your elbow which may get worse over time. Some other symptoms might include:

• Burning or pain on the outer part of your elbow
• Weakness in your grip
• Pain and stiffness when you try to extend your arm
• Sense of pain when you try to twist your arm.
• Difficulty in lifting or bending your arm.

These are some of the most prominent symptoms that might indicate that you are suffering from a tennis elbow. If you feel that you face any of these symptoms, you should seek an orthopedic consultation.

Doctor’s Examination

Your doctor might do a number of things before diagnosing this injury. He will start by asking questions about your injury and how it actually began. He will ask for activities that make the pain worse. Based on the symptoms, doctors may conduct different orthopedic special tests to confirm the problem.  Most of these tests will try to recreate the pain that the person has been dealing with ( provocative tests ), but it won’t cause any further damage. They may also undergo diagnostic imaging to confirm the severity of your injury. These might include:

• X-Rays: To check your bony anatomy and look for any fractures
• MRI: To check the soft tissue structures of your muscles, ligaments, and tendons.

EMG: Your doctor might ask to undergo EMG to check for nerve compressions.

What Treatment Options Are Available for Tennis Elbow?

Based on your injury severity, there are two types of treatment options available for tennis elbow.

Non-Surgical Treatment

Non-surgical treatment has a very high success rate. In most cases, rest is the only thing that a person needs when he is suffering from tennis elbow. There are a few things that you can do to speed up the recovery process and to overcome the injury before it gets any worse.

• RICE – Rest, Ice, Compression, and Elevation
• Using a tennis elbow brace can help you to counteract the forces that cause pain.
• Take NSAIDs and anti-inflammatory medicines like – ibuprofen.
• Use physical therapy to increase the strength and flexibility of your forearm.

Use of Steroid Injections: they can help you to get relief from the symptoms for a considerable period of time.

Surgical Treatment

If your symptoms don’t get any better after non-surgical treatments for over 6 to 12 months, doctors can recommend surgery. Surgical decompression can also be done arthroscopically ( key-hole surgery ) The choice of surgical methodology depends upon various factors like the severity of your injury, your overall health, and your personal needs.

A few surgical options available for you are:

Open Surgery: It is the most common approach used to repair a tennis elbow. An incision is made to your elbow to repair the damaged parts. Most patients that undergo an open surgery for tennis elbow are allowed to go home the same day, depending upon their condition.

Arthroscopic Surgery: It is also similar to open surgery. Small incisions are made to your elbow, and small miniature instruments are used to repair the site of the insertion of the common tendon. Just like open surgery, it is also an outpatient procedure, which means that patients can go home once the surgery is completed.

This is a summary of a common orthopedic condition that is tennis elbow. If you would like more information about the treatments or want to discuss your symptoms, you can always contact Dr. Gowreeson Thevendran or visit www.orthofootMD.com.