STARNBERG, May 23, 2022 (Guest Post)

Table of content:

What is a tennis elbow?

Who suffers from tennis elbow?

What are its causes?

What are its symptoms?

How is tennis elbow diagnosed?

How is it treated?

What is a tennis elbow?

Tennis elbow or lateral epicondylitis is a joint disease that affects the elbow’s tendons. These tendons become inflamed due to microfibrillar tears in the muscle, caused by repetitive movements of wrist extension and supination of the forearm – rotation necessary to turn the palm upwards.

Usually, the overexertion that causes these micro-tears in the extensor muscles of the forearm occurs during the practice of racket sports such as tennis, but also due to repeated movements or excessive efforts of firm grip or rotation of the forearm. For this reason, it can affect the entire population, not only athletes, and in fact, it is a relatively frequent occupational disease in some professions.

The pain may appear locally in the elbow bone or radiate to the forearm muscles and occasionally to the wrist. It can also affect the extensor muscles of the hand and fingers. It can lead to very disabling situations – for example, not being able to drive or open a door – and even limit daily life. It usually affects the dominant arm: the right arm in right-handed people and the left arm in left-handed people.

Who gets a tennis elbow?

Although athletes have a higher incidence of this ailment, tennis elbow can affect many people. It occurs in both men and women, although it appears to be more common in men in their 30s and 40s, and rarely before 20.

Given that anyone who makes repetitive movements of wrist extension and supination of the forearm can suffer from lateral epicondylitis, this ailment has a higher incidence in trades and professionals related to construction, gardening, carpentry, painting, and cooking or domestic cleaning. It is a common ailment among homemakers and is also a common injury among motorcyclists.

What causes it?

When the forearm muscles attached to the bone – called tendons – on the outside of the elbow are used too often, they can develop small tears, which, over time, cause irritation and pain where the tendon attaches to the bone.

Specifically, repeated practice of the following activities or movements can cause tendon tears:

• Playing tennis or other racquet sports very frequently. The backhand is the most common stroke that causes symptoms, but the causes can be multiple: from the lack of the previous warm-up to the use of a too-heavy racket.
• Any activity that involves repetitive twisting of the wrist, such as using a screwdriver or even shaking hands continuously.
• The first use of a motorcycle – getting used to using the brake and clutch – or taking long routes on this vehicle.
• Constant use of the mouse and/or computer keyboard.

What are the symptoms?

Among the most common symptoms of lateral epicondylitis are the following:

• Local pain in the elbow. It may begin suddenly or develop gradually over time.
• Pain radiating from the elbow to the forearm. May increase with gripping, turning knobs, shaking hands, or playing certain sports.
• Loss of strength in the forearm.
• Stiffness and/or mobility problems in the elbow or hands.

How is a tennis elbow diagnosed?

The diagnosis of tennis elbow is clinical and is based on previous symptoms and a physical examination in which the patient may show pain when pressing lightly on the tendon near the site where it attaches to the bone above the outside of the elbow. The patient may also have pain near the elbow when flexing the wrist backward. Your doctor will also check your elbow, wrist, and forearm strength and mobility.

For this purpose, there are several tests:

• Thompson test: used for pain assessment.
• Chair test: lift a chair laterally, with the upper extremity fully against the body and the elbow in extension.
• Bowden test: ask the patient to press on a manometer cuff while it is inflated to a pressure of 30 mmHg.
• Mills test: while standing, with the forearm facing down, elbow in flexion, and hand in extension, the patient is asked to make a supination movement.
• Cozen test: while the patient is seated, elbow flexed, and forearm pronated, the patient is asked to perform an extension of the hand we are opposing.
• Occasionally, the physician may request an X-ray, and likewise, MRI may sometimes show some signs of epicondylitis.

What is its treatment?

The non-surgical treatment of tennis elbow focuses on protection, reducing inflammation, and strengthening the muscles and tendons. This is achieved in the following ways:

• Reducing the activities that cause pain, modifying those that aggravate it – decreasing the time and intensity – and performing rest and stretching. The latter include, in addition to the affected arm, the neck, back, shoulder, hand, wrist, forearm, and triceps.
• If you are a student who plays tennis and you have a symptom of tennis elbow, you will also need to reduce all strain that can somehow stimulate your hand additionally. For example, you should refrain from writing and typing for a while. And if you will need to prepare a written assignment urgently, you can use essay writing help. Remember, health first.
• Your doctor may prescribe nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin.
• Local corticosteroid injections.
• Physical therapy. Modalities such as ultrasound, iontophoresis, massage, or laser treatment.
• Stretching and strengthening exercises of the affected muscles and tendons once the pain has been reduced.
• If epicondylitis does not respond to the above measures, surgical treatment may be necessary, which would consist of an intervention to release part of the bony insertion of the tendon. After surgery, stretching and muscle strengthening exercises should be continued.

7 tips for preventing and relieving tennis elbow:

Tennis elbow can be prevented by taking several simple precautions, especially when playing racquet sports:

1. Supervise your sports equipment.

If you play tennis, you should know that a racket that is too wide or too narrow or too heavy balls can be the culprit of your epicondylitis, for example. Therefore, make sure you choose the most suitable equipment for you and your sport.

2. Correct your technique.

It is also advisable to consult your coach or sports doctor about any changes you can make to your technique to avoid overexerting your tendons. A poorly executed backhand is often one of the leading causes of lateral epicondylitis and excessive force in the racquet’s grip.

3. Warm up before playing and stretch afterward.

Muscles and tendons must be prepared for the effort they will make, so it is crucial to warm them up well before the game with appropriate warm-up exercises.

4. Regulate your activity time.

Sometimes it is a matter of dosing the time we spend playing or performing a repetitive activity. Consider whether you should reduce the frequency or lengthen the rest periods between games in the case of a sport.

5. Learn to stop.

If you notice any pain in the elbow or forearm, immediately stop the activity you think is causing it. Please consult your doctor at the first symptoms and do not return to that sport or activity until he/she tells you to.

6. Strengthen your arm.

Your doctor or physical therapist can teach you exercises that will help you stretch and strengthen your wrist and arm muscles, which will help stabilize the elbow area and reduce the chance of injury. One such exercise is, for example, squeezing a tennis ball.

7. Consult your doctor about the use of elbow pads.

When performing the activity that causes the pain, wearing a band or elbow brace can help relieve or prevent the injury. These solutions increase the area’s temperature by two or three degrees, stimulating circulation and allowing muscles, tendons, and ligaments to relax.