Lateral Epicondylitis – Tennis Elbow
What is Lateral epicondylitis?
Lateral epicondylitis is an overuse syndrome that causes pain on the outside of the elbow. Although it can occur at any age, it is most common between the ages of 40 and 50.The muscles on the outside of the elbow are called the extensor muscles of the wrist and fingers. These muscles move the wrist and fingers (stretching movements, opposite movement to what we do when we clench a fist). The extensor muscles of the fingers and wrist begin (adhere) to the outer epicondyle, a bony protrusion on the inner surface of the elbow with a common tendon.
During the contraction of the extensor muscles, their joint tendon and the lateral epicondyle are burdened. When this load exceeds the strength of the tendon then the tendon is injured. This is usually due to a gradual tendon injury (overuse syndrome) or a direct injury ratio (eg a fall).
Causes of lateral epicondylitis
Although the name “Tennis Elbow” implies that the incidence of injury is high in tennis athletes, one does not need to play tennis to develop lateral epicondylitis. It is a fact that we find it more often in “non-tennis players” than in tennis players. It is directly related to the repetitive contractions of the extensor muscles of the wrist and fingers.
We observe this in athletes of tennis, babington and generally in racket sports.
Also in professions such as carpenter, oil painter, woodcutter, builder, electricians (repeated use of screwdrivers), sewing, knitting and typing.
It is common for the onset of the condition to be associated with the patient’s involvement in an activity for which he was not properly prepared (eg a tennis match after a long absence from the sport). More rarely it appears suddenly. This happens when the extensor muscles are called upon to cope with a load far greater than their strength.
Finally, a serious cause is the wrong technique in tennis.
Symptoms of lateral epicondylitis
The symptoms of lateral epicondylitis usually develop gradually over time. Initially there is discomfort on the outside surface of the elbow which increases with activity. The pain is 1 to 2 cm below the lateral epicondyle, a point which is also sensitive to touch. The pain often reflects up to the wrist. In more severe cases there is pain at night and acute pain with activity.
There is also muscle weakness resulting in a weak grip. Patients with lateral epicondylitis of the elbow experience pain with daily movement such as lifting the glass, turning the door knob, opening a jar or turning the steering wheel while driving.
Stiffness in the elbow area is common especially in the morning.
Subjective (taking a history) and objective (clinical examination) evaluation are sufficient to lead the physiotherapist to diagnose lateral epicondylitis. Further testing (eg diagnostic ultrasound, magnetic resonance imaging) helps to confirm the diagnosis and gives us additional information about the severity of the disease.
In most cases of lateral epicondylitis, patients recover completely with appropriate physical therapy. This requires detailed evaluation and treatment of all risk factors for the development of the disease.
The degree of success of the treatment depends to a large extent on the cooperation of the patient with the physiotherapist. It is very important to avoid activities that increase the symptoms. This helps the body heal damaged tissues. Ignoring the symptoms and pain and continuing to be fully active, the condition progresses to the chronic stage.
Immediate and appropriate treatment is valuable for the rapid recovery of the disease. The treatment in the first 72 hours (acute stage) aims to reduce pain and inflammation. So the patient rests from activities that aggravate the symptoms and uses ice therapy 3 to 4 times a day. A program to improve the strength and elasticity of the extensor muscles of the wrist and fingers should be implemented as soon as possible in the painless range.
Prognosis of lateral epicondylitis
With proper treatment in most cases the recovery takes a few weeks. In case of chronic pain, the recovery lasts up to six months.
Factors for the development of lateral epicondylitis
There are several factors that contribute to the development of lateral epicondylitis. All should be evaluated and corrected by the physiotherapist in collaboration with the patient. Some of them are:
- Excessive or inappropriate work
- Wrong sport technique or wrong equipment
- Muscular weakness
- Muscle stiffness
- Joint stiffness
- Insufficient warm-up
- Inadequate recovery from a previous injury in the area of the match
- History of neck injury
In tennis athletes the size of the racket, the size of the handle, the surface of the court and the weight of the ball play a crucial role in the development of lateral epicondylitis.
Physiotherapy for lateral epicondylitis
Physiotherapy is vital not only for faster and more complete recovery but also for the prevention of the disease. Physiotherapy includes:
- Soft molecule techniques (massage)
- Manual Therapy
- Dry needle technique
- Ice therapy or heat therapy
- Progressive program to strengthen and increase the elasticity of the extensor muscles of the wrist and fingers