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Tennis Elbow
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The term “tennis
elbow” is a lay-term for a condition whose medical name is lateral
epicondylitis of the elbow. Although often found in tennis players, it can
occur in individuals who never play tennis. It is usually an overuse injury
to the tendons on the outside aspect of the elbow. These are the same tendons
that allow one to actively bend the wrist back. If you lay your forearm on a
counter with the palm facing down and then lift your clenched fist off the
counter, you are using the muscles that we are talking about. These muscles
originate as tendons off of a small area on the outside aspect of the elbow.
If you extend your arm in front of you so that the palm is facing up to the
ceiling, this is the part of the elbow on the same side as your thumb. In
tennis elbow, this outside aspect of the elbow is the area of maximum pain. The pain can
sometimes radiate on top of the forearm a little bit. There is usually no
numbness or tingling involved with this condition. |
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What causes tennis
elbow? The start of tennis elbow is thought to be an injury that causes a
small tear in the origin of these muscles. Sometimes this is a one-time
injury. More commonly, however, it is a repetitive overuse injury. Once the
injury occurs, instead of a normal healing response, the body sometimes
creates an ongoing process in which the tissue is not repaired but actually
partially degenerates. This is why this problem can be so persistent. |
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Most of the time, this
can be treated without surgical intervention. However, it can take up to two
years in order for this to occur. In order to treat this successfully, we
need to avoid the offending activity. If you are a tennis player, you may
need to modify your grip size and/or correct swing mechanics in order to take
the stress off the injured area. Some players might even need to restrict
playing for a time, and then slowly return to those activities which do not
cause them discomfort. Also, the way we grasp or lift things may need to be
modified in order to decrease discomfort in this area. |
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In addition to
activity modification, bracing can be used to decrease stress on the injured
area. These are typically braces that look like thick bands that are wrapped
around the forearm just below the elbow. They need to be worn only when doing
activities that cause discomfort, such as playing tennis or grasping or
typing. |
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The mainstay of
treatment for tennis elbow consists of an exercise program. The exercises are
designed to stretch and strengthen the injured area in order to stimulate a
correct healing response. These exercises are done with high repetitions of
about 20-25 per set and about 3-5 sets per workout. These should be done
daily, and one should use very light weight. The average individual should
use no more than 2 to 3 lbs. A very strong individual should use no more than
5 to 10 lbs. |
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Sometimes, however,
the tennis elbow is too inflamed and painful to do much of the exercises or
regular activities. In this situation, an injection of corticosteroids into
the inflamed area can help decrease inflammation and pain to where the
exercises can be performed. These injections can be repeated a couple of
times, if needed. However, the cumulative effect of repeated steroid
injections is detrimental to the health of tendons and can cause numerous
local problems including complete tendon rupture. One must, therefore, be
careful not to keep going back for repeated injections of steroids into the
area of tennis elbow. |
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In a small percentage
of individuals, conservative treatment fails and painful tennis elbow persists
causing discomfort and limited function. In these cases, surgical
procedures can be performed. The results of surgery can be dramatic. However, it can
take many months to recover from this surgical intervention. During this
time, activities performed with that arm are restricted. |
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Exercises for tennis elbow and golfer's elbow: |
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