Understanding Tennis Elbow with Dr. Steffi Faria

Tennis elbow is a common overuse syndrome i.e. the cause is most likely related to repetitive & excessive movement, in this case extending the wrist using the muscles in the forearm. It is also called Lateral Epicondylitis meaning inflammation of the outer side of the elbow, specifically 1-2 cm below the outer bony prominence of the elbow.

It's TendinOSIS, Not Tendinitis!

"-itis" means inflammation. However, studies have shown that, in fact, when viewed under a microscope, the typical signs of inflammation are not present. But mostly, degenerative changes are seen. Hence, the term Lateral Epicondylosis is now being used instead with "-osis" meaning degeneration.

Who is the Most Affected?

In tennis/squash or badminton players who use incorrect techniques to increase the force while hitting backhand, the cause of overuse is overloading the forearm muscles alone instead of activating the big muscles of the entire body like the core, scapula and shoulder muscles (which are very important parts of the orchestra). However, just because it's called "tennis" elbow, doesn't mean it only happens in sports. Repeated use of forearm muscles in carpenters, painters, bakers and mechanics can also lead to this. Also, read about: Tennis Elbow: Symptoms, Causes & Treatment

What Does Tennis Elbow Feel Like?

Mostly the patient comes to us with pain on the outside of the elbow which developed gradually over a period of weeks to months. They don't usually remember a very specific cause but probing into their daily activities/sports techniques, gives clues that point to repeated stress of the forearm muscles which extend the wrist. Also, lifting weights and repeated movements trigger the pain. It's also tender around 1-2 cm below the bony prominence on the outside of the elbow. These are the usual symptoms; however, the pain can also feel like burning. Some complain that their grip has weakened.

Is Imaging Important?

Not really, unless there are other signs and symptoms that don't fit. If after a few weeks of therapy, there is no relief, further imaging may be needed to rule out other causes as well as see the extent of degeneration in the tendon. These include musculoskeletal ultrasound, MRI and Xrays. Sometimes, a disc protrusion in the cervical region could be mimicking symptoms of pain in the same region, for which the neck needs to be evaluated as well.

How Do You Treat It?

Physical therapy is very helpful in uncomplicated cases of tennis elbow. It is important to progress carefully and follow protocol, beginning with stretching and strength training (concentric to eccentric exercises). It is as important to work on the core, shoulder and scapular muscles, as we forget that these play an important role in the orchestra of sports. Proper ergonomic corrections and improvement in sports techniques are also essential to prevent recurrences which are very common in tennis elbow. Adjuncts to this include a variety of treatments like injection therapy, shock wave therapy, local application of painkiller gel, judicious use of oral anti-inflammatory medicines, bracing and if all else fails, surgery.

Wait and Watch Approach?

Because tennis elbow usually develops gradually or because it is usually a wait and watch approach for many patients, it is commonly seen that the issue becomes chronic. Such chronic pain patients are at the risk of developing "central sensitization". Putting it simply, the brain and nerves over a fire even though the initial cause of the pain may have been eliminated. Now they have a pain cycle that feeds itself and can cause symptoms that spread out above and below the original site with varying intensity. It can start affecting mood, cause fatigue, cognitive issues and sleep disturbances. The solution to such cases is desensitization, which occurs with good strengthening and proper maintenance. However, it is also important that the patient knows that recovery may be slower in chronic cases because of this phenomenon of over firing pain circuits. Whether anyone suffers from acute or chronic tennis elbow, it is strongly recommended by AktivHealth, to dedicate time and effort to physical therapy. 80-90% of cases benefit from a planned therapy program and activity modification. Even after guided training and therapy, a little bit of your own maintenance through an easy and tailored home exercise program goes a long way in preventing recurrences. It is also important that other causes that mimic the symptoms of tennis elbow be ruled out in case therapy does not achieve results.

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About The Author

This article is written by Dr Steffi Andrat Faria, M.D. (Physical Medicine & Rehabilitation) at AktivHealth (Delhi & NCR).