Introduction

Tennis elbow also called lateral epicondylitis.

This is a condition characterized by pain and acute tenderness on the lateral side of the elbow usually related to common extensor tendon,but the pain may radiate down the back of your forearm.It is mainly seen in age of 30 to 60 years in both male and females.Despite its name,athletes aren't the only one's who develop tennis elbow.The one's who do jobs that feature the types of motions that can lead to tennis elbow such as plumbers,painters,carpenters,butchers etc.

Cause

Tennis elbow is mainly caused due to overuse of wrist extensors.The repeated motion and stress to the tissue may result in a series of tiny tears in the tendons that attach the forearm muscles to the bony prominence at the outside of your elbow.

As the name suggests,playing tennis-- especially repeated use of the backhand stroke with poor technique--is one possible cause of tennis elbow. However,many other common arm motions can cause tennis elbow, these includes:

Carrying a heavy case.

Wrong technique at sport(e.g. tennis,golf,badminton,fencing).

Unacustomed gardening or carpenter.

Cutting up cooking ingredients,particularly meat.

Repetitive use of mouse of a computer.

Pathology

A tear occurs at the teno-muscular junction,in the tendon or at the teno-periosteal junction.The resulting inflammation produces exudate in which fibrin forms to heal the torn tissue.If excessive fibrin is formed fibrous tissue will result in adhesions between the tendon and the neighbouring tissues.This causes pain on being stretched and impairs function.This may occur in one episode but is more commonly a long-term low-grade process.A subperiosteal hematoma may form.

Repeated use and minor injury to the tendon prevent healing and excessive scar tissue can form.

Symptoms

You may experience the following symptoms mentioned below if you develop tennis elbow:

Pain in the elbow i.e.mild in the beginning but gets worse after time.
Pain felt during activities such as lifting something,using tools,opening jars etc.
Pain can be felt while shaking hands or squeezing an object.
Pain will be felt to be radiating from outside of the elbow down to the forearm and wrist.

Clinical Features:

Pain: Gradual onset present after activity ,disappears with rest.With time it takes longer to go,is more easily aggravated and may be more intense.

Referred Pain:Aching or sharp pain over the wrist extensors from elbow to wrist.

Movements:Elbow,radio-ulnar,wrist and hand joints have full active range.Resisted wrist extension is painful;passive movement is fain free.

Muscle Power:This is normal at first but becomes diminished as the patient stops using the arm.

Palpation:Tenderness is present over the tendon and is more acute at the site of the lesion.There may be thickening of the tendon and loss of mobility.

Long term:Acessory movements of the elbow and superior radio-ulnar joints may be reduced in a long term problem.

Risk Factors:

Here i will discuss the factors that may increase the risk of tennis elbow,

It includes:

Age.Tennis elbow affects people of all ages,but its most common in adults or age group of 30-60 years.
Occupation.People who have jobs that involve repetitive motions of the wrists and arm are more likely to develop tennis elbow.For example plumbers,painters,carpenters,butchers,cooks etc.
Certain sports.Sports persons specially those who are involved in sports like lawn tennis,badminton,table tennis etc,who have poor stroke techniques develop tennis elbow.

Physiotherapy

This has to relate to whether the condition is acute or chronic

Acute

Ice applied after a game or activity helps to reduce inflammation.It is usually applied in a towel for 15-20 minutes.

Rest is also appropriate.A splint which holds the wrist in extension may be used for 2 or 3 weeks, until resisted extension is pain free.

Strapping may be used in the form of adhesive elastic tape applied to the forearm to resist the movement of the tendon and ensure that healing occurs without lengthening.

Once healing has occured ,the cause of the injury should be analysed, e.g. the thickness of the racket grip.

If there is residual thickening or immobility of the tendon,this responds well to deep transverse frictions.

Chronic

This is the more common form of the condition because the patient at first thinks the pain will go away and seeks helps only when it becomes constant or functionally restricting.

Examination must be meticulous to enable identification of the lesion.

Modalities used

Rest.
Ice.
NSAIDS.
Steroid injections.
Deep tranverse frictions.
Ultrasound.
Pulsed electromagnetic energy or ice.
Laser Therapy.

Physiotherapeutic exercises for tennis elbow

Soft tissue mobilization

Procedure:

Sit comfortably in a good posture.
Now you need to feel where the muscles are getting attached.
After that,you need to mobilize the area slowly(don`t just rub).
Mobilize the area in circular motion/side-to-side motion/up and down motion.
Repeat it 10-15 times in different motions.
Practice this twice daily.

Wrist extensors stretch

*Push your fist downwards and hold the stretch

Procedure:

Sit comfortably with good posture.
Extend your elbow and make a fist with your hand.
Put your arm straight out.
Now, with other hand help push it downwards and hold that stretch.

Wrist flexor stretch

*Push your fingers towards your body

Procedure:

Sit comfortably with good posture.
With your elbow extended put your arm straight.
Now,bring your fingers up,push your fingers towards your body until you feel the stretch.
When you feel the stretch hold it for 10-15 seconds ans then relax.

Wrist extension with elbow flexion

This exercise increases active range of motion (AROM) and blood circulation of the forearm.

Slowly bring it up

Slowly bring it down

Procedure:

Sit comfortably with good posture.
Bend your elbow and place your arm on the table.
Bring your wrist just off the table.
Now, make a fist with your hand.
Slowly bring it up and slowly bring it down.
Repeat this exercise 10-15 times.
Practice it twice daily.

STRENGTHENING EXERCISES

Wrist extension with weight

Palm down

Palm up

Procedure:

Sit comfortably with a good posture.
Take small weights 1-2 pounds or you can use soup or vegetable can.
Place your elbow on the table with your arms slight off the table.
Now,put your palm down holding the weight and slowly bring it up.
Repeat this exercise 10-15 times.
Perform it twice daily.

Radial and ulnar deviation range of motion with elbow flexion.

Fist in (towards your body)

Fist out (away from your body)

Procedure:

Sit comfortably with a good posture.
Bend your elbow place it on a table.
Place your forearm just off the table.
Make a fist with your hand.
Now,move your fist in ( towards your body ) and slowly out ( away from your body).

Radial deviation with weight

Go up

Go down

Procedure:

Sit comfortably with a good posture.
Bend your elbow place it on a table.
Place your forearm just off the table.
Hold the can with your thumb up and go up and down.
Repeat this motion for 10-15 times.
Practice it twice daily.

Wrist supination and pronation

Turn your wrist to supination

Turn your wrist to pronation

Procedure:

Sit comfortably with a good posture.
Put your elbow by your side and put your fingers out.
Then turn your wrist to supination and again in pronation.
Repeat this motion for 10-15 times.
Perform it twice daily.

NOTE:Perfrom this exercise in pain free motion.

Wrist supination and pronation with weight

Take a hammer in supination

Take the hammer in pronation

Procedure:

Sit comfortably with a good posture.
Binge your elbow by your side
Now, take a hammer and go out in supination and bring back in pronation.
Repeat this motion for 10-15 times.
Perform it twice daily.

Towel twist with wrist extension.

Procedure:

Sit comfortably with good posture.
Keep your hands and shoulder relaxed.
Twist the towel with both the hands in opposite direction as if you are wringing out water.
Repeat it 10-15 times in both the directions.

Warning

Always consult your physiotherapist or physician before beginning any exercise program.Your physiotherapist will never begin any exercise program until inflammation has subsided,as it may ruin the condition. If pain persists or returns after any activity you should stop doing any kind of activity,rest and ice your forearm.Make sure you do your exercise correctly under your physiotherapists supervision.

Preventive Measures

If you have had tennis elbow in the past or if you are recovering from it now,try exercises which aids strengthening the muscles of your forearm and make sure you avoid using your forearm muscles more, to keep pain away. and avoid the issue in the future.

Picture credit

AskDoctorJo