Tennis elbow is a condition characterized by development of pain and soreness in the outer part of the elbow. It occurs when the muscles in this region are overused due to repetitive movement involving the wrist and arm.
Presentation
Tennis elbow may present with pain that would radiate from outside of the elbow to the forearm and wrist. Pain would make movement of the hand difficult. Individuals with tennis elbow would also find it difficult to hold a cup, shake hands and turn a door knob. Without treatment, the pain gradually worsens and affected individuals also slowly lose the power to grasp.
Individuals who have developed tennis elbow would also experience morning stiffness in the area affected and pain from activities that utilize muscles of the affected area. Activities such as lifting and wrist extension would be painful for affected individuals.
Entire Body System
- Pain
Faint pain a couple of hours after the provoking activity. 2. Pain at the end of or immediately after the provoking activity. 3. Pain during the provoking activity, which intensifies after ceasing that activity. 4. [physio-pedia.com]
Recently, we demonstrated vascularity in the extensor origin in patients with chronic painful tennis elbow, but not in controls with pain-free elbows. [ncbi.nlm.nih.gov]
and lifting movementsSymptoms associated with tennis elbow include, but are not limited to, radiating pain from the outside of the elbow to the forearm and wrist, pain during extension of wrist, weakness of the forearm, a painful grip while shaking [en.wikipedia.org]
When overused, the tendon can degenerate and cause pain in the area. It is particularly painful in patients who must do repeated wrist extension activities. [ucsfhealth.org]
Patients with LUCL injuries will have pain and the sensation of instability when the elbow is extended, and the forearm is supinated. [rheumatologyadvisor.com]
- Swelling
In addition to pain, you may have swelling around your elbow joint. Causes What causes tennis elbow? Overuse causes most cases of tennis elbow. It occurs when repeated movements cause swelling and pain in your joint and tendons. [familydoctor.org]
Ice helps prevent tissue damage and decreases swelling and pain. Elevate your elbow above the level of your heart as often as you can. This will help decrease swelling and pain. Prop your elbow on pillows or blankets to keep it elevated comfortably. [drugs.com]
While there can be swelling, that's not always the case. "And usually there is no specific injury that a patient can relate the onset of symptoms to," she says. [fitnessmagazine.com]
However, you may not have any swelling if your injury is minor. On the other hand, major swelling in the area may indicate a worse injury, such as a break or tear. [4] Visit your doctor if you have a lot of swelling. [wikihow.com]
- Disability
The mean Disability of the Arm, Shoulder and Hand score improved from 32 points preoperatively to 15 points at 3 months after surgery (P < .001). [ncbi.nlm.nih.gov]
- Forearm Pain
However, lateral elbow and forearm pain may come from other causes and can easily be mistaken for lateral epicondylitis. [massagetoday.com]
BACKGROUND: The Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire is a tool designed for self-assessment of forearm pain and disability in patients with lateral elbow tendinopathy (LET). [ncbi.nlm.nih.gov]
Pain occurs in the outside of the forearm when the wrist is extended away from the palm. Pain can extend from around the elbow to the middle of the forearm. Pain may be increased by firm gripping (handshaking) or even turning door knobs. [merckmanuals.com]
Tennis elbow : reactive tendon pathology of extensor forearm muscle origins, causing lateral elbow and upper forearm pain and tenderness. [patient.info]
- Arm Pain
Signs and symptoms of an Tennis Elbow may include: Pain at or around the lateral elbow Often very tender to touch over the lateral epicondyle Pain may radiate up or down the arm Pain may worsen when reaching, gripping or lifting objects Occasionally, [tria.com]
These may include arm exercises, ice massage, and muscle-stimulating techniques. Ultrasound therapy: In ultrasound therapy, an ultrasound probe is placed over the most painful area on your arm. [healthline.com]
Your dominant arm is most often affected; however both arms can be affected. Your doctor will consider many factors in making a diagnosis. [orthoinfo.aaos.org]
Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance. You may also feel pain when you try to lift and grip small objects, such as a coffee cup. [urmc.rochester.edu]
Sufferers may find it difficult to fully extend or bend their arms, and will often report additional pain when lifting, gripping, or twisting with the affected arm. Pain is often reported to be more prevalent in the morning, after sleep. [squashskills.com]
Skin
- Erythema
Swelling, erythema, and asymmetry are commonly noted when examining pathologic tendons. Joint effusions are uncommon with tendinopathy and suggest the possibility of intra-articular pathology. [aafp.org]
Musculoskeletal
- Elbow Pain
Abstract Tennis elbow (Epicondylitis humeri radialis) is the most frequent reason that patients with elbow pain report to a physician. The exact cause of elbow pain is still unclear. [ncbi.nlm.nih.gov]
Participants: 32 affected elbows (median and range of duration: 10; 3–120 months) and 18 unaffected contralateral elbows in 25 patients (mean age 50 years) with lateral elbow pain, and 38 unaffected elbows in 19 asymptomatic participants (mean age 45 [doi.org]
- Muscle Weakness
Because botulinum toxin injection did not relieve pain significantly but is associated with weakness, the muscle weakness caused by botulinum toxin is unlikely to be the sole mechanism of the pain relief observed in previous studies. [ncbi.nlm.nih.gov]
Sometimes the weakness is in the muscles of the wrist and forearm. In many cases, the problem stems from weakness of the supporting postural, or "core," muscles. [moveforwardpt.com]
Forearm pain may accompany weakness when the extensor muscles are contracted significantly because the sensory fibers in the affected muscles are being stimulated. [massagetoday.com]
An associated ulnar neuropathy may cause decreased sensation and/or a tingling sensation in the 4th and 5th fingers and, in more severe cases, muscle weakness in the hand. Enquire about activities which may have caused the tendinopathy. [patient.info]
- Elbow Swelling
Overview What is tennis elbow? Tennis elbow is another name for lateral epicondylitis. It occurs when the tendons that attach the muscle to the bone on the outside part of the elbow swell or tear. [familydoctor.org]
Symptoms of Tennis Elbow & Diagnosis Symptom of tennis elbow commonly include: ( 10 ) Pain, tenderness and swelling around the elbow. [draxe.com]
- Joint Stiffness
Patients with epicondylitis will also experience: Joint stiffness, particularly in the morning Joint weakness Numbness or tingling sensations that radiate down into the fingers Interestingly, though epicondylitis generally emerges as the result of injury [paindoctor.com]
While stiffness doesn't cause pain it can make your elbow feel uncomfortable. Losing any range of movement is called stiffness. Stiffness can happen due to problems with your elbow joint itself, or the muscles, ligaments or covering of the joint. [arthritisresearchuk.org]
- Tendon Disorder
Treatment of tendon disorders: is there a role for corticosteroid injection? Foot Ankle Clin. 2002;7(3):501-51312512406 PubMed Google Scholar Crossref 26. Ljung BO, Alfredson H, Forsgren S. [doi.org]
Psychiatrical
- Withdrawn
The trusted provider of medical information since 1899 DRUG INFO Commonly searched drugs Aspirin Metformin Warfarin Tramadol Lactulose Ranitidine (Withdrawn from US Market) Paul L. [merckmanuals.com]
Neurologic
- Confusion
For the minority of people with lateral epicondylitis who do not respond to nonoperative treatment, surgical intervention is an option, but confusion exists because of the plethora of options. [ncbi.nlm.nih.gov]
The symptoms of these conditions are usually distinct, but in some cases they can be confusing. These conditions should be considered if the symptoms are not typical for tennis elbow or if the patient does not respond to treatment. [orthopedics.about.com]
Other pathology about the elbow can be confused with tennis elbow syndrome, including pressure on the radial nerve in the region of the elbow (radial tunnel syndrome), instability of the elbow, or arthritis of the elbow. [indianahandtoshoulder.com]
Radial tunnel syndrome is an unusual type of nerve entrapment that is sometimes confused with or can develop at the same time as tennis elbow. What Happens Tennis elbow pain is a symptom of tendon injury. [myhealth.alberta.ca]
Workup
A preliminary physical examination to evaluate the extent of motion ability of the elbow, forearm and wrist would be carried out. The individual would also be asked to move his fingers in various ways to analyze the restricted mobility of the fingers. In many cases, physical examination is enough to diagnose the condition. However, certain others tests may need to be conducted to further confirm the diagnosis. X-rays and other imaging studies of the affected area may help to arrive at a definite diagnosis [6] [7].
Treatment
Mild cases of tennis elbow often resolve on their own. Over the counter pain relieving medications along with physical therapy may also be beneficial. Physical therapy has strong basis in treatment of tennis elbow. The following methods of physical therapy include [8]:
- Proper techniques: Learning and mastering the art of proper techniques while playing tennis will help reduce the incidence of tennis elbow. Players should seek help from experts to learn the proper movements that would help exert minimal pressure on the injured tissue.
- Exercises: Exercises go a long way in strengthening the muscles of the forearm. A physiotherapist would teach individuals various types of exercises that would aid in easy stretching of the forearm muscles.
- Physical support: Physical support in the form of braces would also be provided to be worn on the forearm. This would help relieve the pressure and stress on the injured tissue [9].
When over the counter medications and physical therapy do not seem to work then surgery may be implicated in such cases. Surgical intervention to remove the damaged tissue is conducted. However, extensive physical therapy would be extremely necessary for recovery.
Prognosis
The prognosis of the condition is favorable with medications and individuals do not always require surgical intervention. However, those who have undergone surgery can fully utilize their elbow and forearm post surgery.
Etiology
The major cause of tennis elbow is repetitive use of the extensor muscle of the forearm [2]. Such an activity causes muscles strain injury which in turn predisposes an individual to develop tennis elbow. The type of arm motion employed by tennis players, that of the backhand stroke, is known to be the most common cause of tennis elbow. However, the condition can also occur in other types of motions involved while using plumbing tools, driving screws and painting [3].
Epidemiology
Tennis elbow is a common condition affecting about 5 in 1000 adults annually. Individuals between the age group of 35 to 55 years more commonly fall prey to the condition. Men and women are equally affected and it is a common occurrence in those with unfit forearm muscles.
Tennis elbow affects about 39.7% of tennis players. Of these, about 50 of them reported their symptoms to be debilitating and severe. The duration of playing tennis is also considered to be an important marker for development of tennis elbow. It has been reported that those players who play for more than 2 hours a day are at an increased risk of developing the condition [4].
Pathophysiology
Repeated use of the extensor muscles of the forearm causes tennis elbow. When these muscles are repeatedly used then small tear develops in the tendons. The tendons which attach the muscles of the forearm to the bone of the elbow undergo tear as a result of repeated peculiar kind of motion. As the condition progresses, irritation and pain develops at the site of tear.
The condition is a common occurrence amongst tennis players who frequently use the backhand stroke. Activities that involve repeated wrist movements also can lead to tennis elbow [5].
Prevention
It is not always possible to prevent the development of tennis elbow. Individuals are advised to seek prompt treatment to prevent onset of irreversible damages. When individuals develop tennis elbow they should restrict any movement concerning the forearm and the wrist. Exercises are a great way of strengthening the muscles which can prevent injury to the forearm muscles [10].
Summary
In addition to tennis players, the condition also strikes carpenters, plumbers, painters and butchers. This is because such kind of people repeatedly make use of the extensor muscles of the forearm which predisposes them to develop tennis elbow. In majority of the cases, over the counter medications can help relieve the pain caused due to tennis elbow. However, when these do not work, surgery may be indicated [1].
Patient Information
Definition
Tennis elbow is characterized by development of pain in the lateral side of the upper arm. It is a common occurrence amongst tennis players. However, individuals who are in other occupation of painting and carpentry also fall prey to tennis elbow.
Cause
Repeated use of forearm muscles induces stress and causes tear in the tendons that join the muscles to the bone of the elbow. Tennis players develop the condition due to constant use of the backhand stroke while playing tennis.
Symptoms
Symptoms of tennis elbow include pain that originates on the lateral side of the upper arm and radiates down the wrist. Movements become difficult and individuals experience great deal of discomfort while performing activities such as stretching and pulling.
Diagnosis
In many cases, physical examination to study the motion ability of the wrist and forearm is enough for diagnosis. However, imaging studies such as X-rays and MRI can be done to confirm the diagnosis.
Treatment
Over the counter pain medications along with physical therapy helps in treating the condition. Braces in the form of physical support may also be advised to support the affected area. However, when conservative therapy does not work for more than 6 to 12 months, then surgery may be carried out to remove the damaged tissue.
References
- Behr CT, Altchek DW. The elbow. Clin Sports Med 1997; 16:681.
- Zeisig E, Ohberg L, Alfredson H. Extensor origin vascularity related to pain in patients with Tennis elbow. Knee Surg Sports Traumatol Arthrosc 2006; 14:659.
- Nirschl RP. The etiology and treatment of tennis elbow. J Sports Med 1974; 2:308.
- Nirschl RP. Elbow tendinosis/tennis elbow. Clin Sports Med 1992; 11:851.
- Giangarra CE, Conroy B, Jobe FW, et al. Electromyographic and cinematographic analysis of elbow function in tennis players using single- and double-handed backhand strokes. Am J Sports Med 1993; 21:394.
- Aoki M, Wada T, Isogai S, et al. Magnetic resonance imaging findings of refractory tennis elbows and their relationship to surgical treatment. J Shoulder Elbow Surg 2005; 14:172.
- Kibler WB. Clinical biomechanics of the elbow in tennis: implications for evaluation and diagnosis. Med Sci Sports Exerc 1994; 26:1203.
- Bisset L, Beller E, Jull G, et al. Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ 2006; 333:939.
- Walther M, Kirschner S, Koenig A, et al. Biomechanical evaluation of braces used for the treatment of epicondylitis. J Shoulder Elbow Surg 2002; 11:265.
- Snyder-Mackler L, Epler M. Effect of standard and Aircast tennis elbow bands on integrated electromyography of forearm extensor musculature proximal to the bands. Am J Sports Med 1989; 17:278.