TENNIS ELBOW

Tennis elbow (or lateral epicondylitis) is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse.

While it is called "tennis elbow", it should be noted that it is by no means restricted to tennis players. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to the complaint.

Symptoms

• Outer part of elbow (lateral epicondyle) tender to touch.
• Lateral elbow pain radiating to extensor aspect of the forearm.
• Movements of the elbow or wrist hurt, especially lifting movements.
• Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee.
• Pain usually subsides overnight.
• If no treatment given, can become chronic and more difficult to eradicate.

Treatment

Although not founded in clinical research, the tennis player's treatment of choice is frequent icing and compression (Cold compression therapy) for inflammation, and taking anti-inflammatory pain-killers, such as ibuprofen. In general the evidence base for intervention measures is poor. A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain. Also, ergonomic considerations are important to help with the successful relief of lateral elbow pain.

Initial measures

Rest, ice and compression are the treatments of choice. There are many excellent cold compression therapy products available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain, and inflammation.

Exercises and stretches

Stretches and strengthening exercises are essential to prevent re-irritation of the tendon. Progressive strengthening for this condition involves using weights or elastic theraband to increase wrist flexion strength (grip strength). Racquet sport players also are commonly advised to strengthen their shoulder rotator cuff and scapula muscles to reduce any overcompensation in the wrist flexors in gross arm movements (such as a swing).

Physiotherapy

With physiotherapy, ultrasound can be used to reduce the inflammation and promote collagen production although the current evidence for its efficacy is inconclusive. Manual therapy (a form of physiotherapy) is an important part of the treatment; and can take the form of elbow joint mobilisations/manipulations and/or extensor muscle tissue mobilisations. Nerve mobilisation can also be helpful if the Physiotherapist finds a positive nerve tension test in their assessment. The most common upper limb nerve found to be sensitive is the radial nerve for this condition. Elbow clasps are also found to give temporary relief of symptoms.

Local steroid injections

Intra-articular glucocorticoid steroid injections can resolve episodes for several months, but there is a risk of later recurrence. Following an injection, the patient normally experiences increased pain over the subsequent day before the steroid starts to settle the condition over the next few days. As with any steroid injection, there is a small risk of local infection and tendon rupture. Most doctors will restrict after two injections giving further courses, as there is less likelihood of effectiveness but increased risk of side-effects.

As opposed to short-term effects, the longterm benefits of local steroid injection are less clearly established.

Surgery

If conservative measures fail, release of the common extensor origin may be helpful.

Source: wikipedia GFDL