Tennis Elbow

Tennis elbow is an overuse condition affecting the extensor muscles of the forearm. It is also known as lateral epicondylalgia or tendinitis. Patients will typically experience pain where the tendon of your forearm connect on the outside of your elbow. Some individuals can also feel painful sensations that have spread down to the forearm and wrist area. Conditions impacting all tendons are usually the result of too much, too soon and are common when starting a new activity, job, sport, or home project. Tennis Elbow or lateral Epicondylitis is a painful condition of the lateral elbow often associated with overuse. Treatment and management of this condition varies enormously partly because the pathology is not always understood.

Historically this condition has been labeled as Tendonitis, which means inflammation of the tendon. Tendon inflammation is rarely the cause of tendon pain. "Tendinosis" refers to micro tears in the tendon and is associated with overuse of the tendon. In the majority of cases this condition is better described as tendinosis and needs to be treated as an "overuse" condition rather than simply inflammation.

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Causes of Tennis Elbow

Tennis elbow occurs with too much or too little activity of this muscle group in the elbow. Repetitive activities involving the upper extremity, repetitive gripping, and repetitive vibration are typically to blame. Despite the name, it is typical to see this condition occur in other sport related activities such as baseball, swimming, and badminton; desk workers, carpenters, and gardeners can find themselves with tennis elbow, as well. Tennis elbow can occur in all ages, but it most commonly affects those ages 30-50.

Some of the most common causes of Tennis Elbow include overuse, age, and changes in activity. Overuse: Typically related to repetitive activity either with sport: tennis, weightlifting, golf or with occupation: keyboard entry, painters, plumbers, carpenters, autoworkers, cooks. Age: Most common between ages 30-50, but if related to poor technique can come on at any stage of life. Change In Activity: Frequently symptoms start after a change in type or frequency of activity; either sport, recreational or workrelated.

  • Overuse with Repetitive Activities
  • Too Much or Too Little Activity of Muscles in Elbow
  • Repetitive Activities and Overuse of Elbow and Supporting Structures
  • Age and Other Health Risk Factors

Symptoms of Tennis Elbow

Patients will typically experience pain where the tendon of your forearm connect on the outside of your elbow. Some individuals can also feel painful sensations that have spread down to the forearm and wrist area. It can become painful and difficult to perform day-to-day tasks like gripping, holding a coffee cup, or turning a doorknob.

In the beginning, faint elbow pain can be expected immediately following activity or a few hours after a repetitive activity. If left untreated, pain can become constant limiting most activities. Normally begin slowly and gradually worsen over weeks or months. Pain or burning over the lateral elbow, sometimes extending down the forearm to the wrist. Patients can also experience a loss of grip strength. Pain can increase by forearm activities-such as shaking hands, holding a racquet, using a tool.

Symptoms can persist long enough to contribute to numbness and tingling in the affected forearm. This is common if there is a history of neck pain and important for the physical therapist to know.

  • Pain on the Forearm at the Tendon Connection
  • Difficulty Performing Everyday Tasks
  • Pain Down Forearm and Wrist
  • Numbness and Tingling in Forearm
  • Loss of Grip Strength
  • Increase in Pain After Certain Activities

Diagnosis of Tennis Elbow

A physical therapist is the ideal provider to diagnose and treat tennis elbow. Your physical therapist can assess your range of motion, strength, and joint mobility to determine the causative factors of this condition and rule out any other conditions that may cause pain to the outside of the elbow. Your primary care physician or orthopedic physician may diagnose this condition and refer you to one of our therapists for further assessment and treatment, especially if your pain is limiting your day-to-day function.

Signs and symptoms include pain along the outside of the elbow into the forearm and/or wrist, decreased and painful grip strength, pain and stiffness in the elbow, forearm, and wrist, and weakness in surrounding muscle groups.

In the instances of trauma or a fall, your physician or physical therapist may refer you for an X-Ray to rule out a fracture.

Treatment of Tennis Elbow with Physical Therapy

Conservative treatment will be successful in greater than 90% of cases. Better outcomes are achieved when treatment is initiated earlier. Anti-Inflammatory medication and/or a local steroid injection are useful in conjunction with PT to assist in allowing a more progressive exercise program.

Relative Rest — A short period of rest from aggravating activities may be needed to initiate healing. Successful PT involves re-introducing activity gradually once the patient is responding to the eccentric exercise program.

Ice — Patient education in the use of ice is important. Ice should be applied immediately at the completion of aggravating activities (sport, work, etc).

Manual Therapy — Soft-tissue release techniques are applied to prevent adhesions at the tendon attachment, and to release tightness in the opposing muscle group (the fl exors). Joint treatments may be applied at the cervical spine if involvement is indicated from the assessment. Joint mobilization to the elbow has been found to improve grip strength, decrease pain and improve function.

Your physical therapist’s aim is to reduce pain and improve function. After a thorough assessment, you will be given advice on pain management and modifications you can make throughout your care with Results. These modifications can be specific to you and your goals.

Hands on, manual therapy techniques will be used to improve pain and stiffness along the elbow, forearm and wrist. This will make gripping and strengthening less painful so that you are able to do more. Your therapist may recommend trigger point dry needling, taping techniques, and other pain relieving modalities to get you better, faster. Specific exercises will be prescribed to improve your elbow tendon’s ability to perform the tasks you need to do. Your therapist will also give you specific stretches and exercises to do at home to continue your recovery.

If you have a history of neck pain, numbness, or tingling, your therapist may provide similar treatments to your cervical spine to assist in treating your elbow pain.

After your evaluation, your therapist will be able to discuss a more timeline for recovery. Significant improvement is expected within the first few weeks of seeing a therapist. Full recovery is possible, but if this condition has persisted for several months or years, patients can expect a longer duration of care for management of this condition.

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Prevention Tips for Tennis Elbow

Repetitive activities of the elbow, wrist, and hand contribute to tennis elbow. Early intervention is key in managing this condition so that it does not persist. Maintaining the strength of your grip and mobility of your elbow, wrist, and hand can be a big help in preventing tennis elbow.

Varying or rotating your day-to-day tasks, sports, work, and recreational activities throughout the day or week can alleviate the strain of your elbow. Tools and raquets with larger grips can reduce the loads through your elbow making repetitive gripping or striking more comfortable.

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