MotionPlus Monthly: Lateral Epicondylitis Aka Tennis Elbow

Lateral epicondylitis, commonly known as tennis elbow, is the inflammation of the attachments of the extensor muscles in the forearm. The pain associated with this condition originates at the outside of the elbow.

Symptoms of tennis elbow

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  • Pain on the outer part of the elbow (lateral epicondyle)
  • Point tenderness over the lateral epicondyle—a prominent part of the bone on the outside of the elbow
  • Pain from gripping and movements of the wrist, especially wrist extension (e.g. tunning a door handle, lifting a barbell) and lifting movements, such as picking up weights.

 

The common response I get from my clients when I diagnose them with tennis elbow is, “But I don’t play tennis”. This is true for most of my clients, but it is actually the movement of extension of the wrist (bring your fingers and wrist back towards your elbow) which is the movement associated with tennis elbow. If you repeat this movement enough it becomes an overuse mechanism which will predispose you to injury. Although I see a lot of sporting injuries, this injury does not just occur in the sporting population it is also present in the working community (Descatha, Albo, Leclerc, Carton, Godeau, Roquelaure, Petit and Aublet-Cuvelier, 2016).

 

What tests do I use to see if you have Tennis elbow?

Diagnosis

  • Mills test: The patient is seated with the upper arm relaxed at side and the elbow extended. The examiner passively stretches the wrist in flexion and pronation. Pain at the lateral epicondyle (outside of the elbow) or proximal musculotendinous junction of wrist extensors is positive for lateral epicondylitis (tennis elbow).
  • Maudsley's test: Resisted third digit extension (the third finger).
  • Cozen test: resisted wrist extension with radial deviation and full pronation.
  • Chairlift test: lifting the back of a chair a three pinch (thumb, index long finger) and the elbow fully extension.

However, an Ultrasound will provide myself or your healthcare professional with the best diagnosis.

Management

Relieving your pain at the elbow can be achieved by rest and avoiding painful activities. Inflammation can also be prevented by NSAIDs in the acute cases. However, due to my scope of practice, this is best to talk to your g.p or sports doctor. The use of ice is a commonly recommended practice because it reduces the inflammatory response by decreasing the level of chemical activity and by vasoconstriction, which in turn helps reduce the swelling.

The use of an elbow brace or tape (personal favourites of mine are Rock Tape or K tape) can be helpful because it plays the role of a secondary muscle attachment site and relieves tension on the attachment at the lateral epicondyle. This will provide extra benefits for your healing.

Exercises have been shown to be beneficial for your rehab and prehab (Viswas, Ramachandran & Anantkumar, 2012, Page, 2010). Furthermore, Peterson, Bulter, Eriksson and Svärdsudd (2014) have promoted that eccentric graded exercises help reduce pain and increase muscle strength in chronic tennis elbow more effectively than concentric graded exercise.

Treatment, as indicated, can be of benefit for improving your symptoms of tennis elbow. Küçükşen, Yilmaz, Sallı & Uğurlu (2013), concluded that osteopathic treatment, helped measurements of strength, pain, and function, especially in pain-free grip strength and pain in comparison to the other form of treatment of corticosteroid injections.

Sevie and Stegink-Jansen (2015) concluded that in their study suggests the use of IASTM can prove to be an effective treatment option for patients with tennis elbow, as an initial treatment, and after an eccentric exercise program has failed.

When you to rehab your injury, it is essential that you look at what has caused this. If it is in a sporting code you can look at your technique, as this does increase the chance of injury. Therefore, you should learn the proper techniques required for all aspects of your sport. If you are at a competitive level your incidence level of tennis elbow will increase. However, there is also an increasingly higher rate of injury as your ability level decreases.

As mentioned earlier, the cause of tennis elbow can also be from your working environment. Therefore going through prevention measures such as work condition and workstation is additionally very important.

Preventive measures

  • Decrease the amount of playing time and start rehabbing that injury, then prehab yourself so this doesn’t come about again.
  • Stay in overall good physical shape.
  • Strengthen the muscles of the forearm, the upper arm, the shoulder and upper back. Increasing the muscular strength increases the stability of joints such as the elbow. Thus, helping with prevention.
  • Use equipment appropriate to your ability, body size, and muscular strength.
  • Avoid any repetitive lifting or pulling of heavy objects (especially over your head). However, if this is the case then not to worry, you can do further rehab/prehab work to prevent this from happening.

Furthermore, this isn’t medical advice, this post is an educational post to help you understand your problem. If you want further information or need to see someone in regards to your tennis elbow either go see your Osteo or your healthcare provider.

Final note, If this is your first time on my page, press "learn more" as this will take you to the previous post about rehab exercises.

 

Take care of yourself and see you next month

Reference

Descatha, A., Albo, F., Leclerc, A., Carton, M. Godeau, D., Roquelaure, Y.,  Petit, A., & Aublet-Cuvelier, A. (2016). Lateral Epicondylitis and Physical Exposure at Work? A Review of Prospective Studies and Meta-Analysis. Arthritis Care & Research; 68(11), pp 1681-1687. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/acr.22874/full

Küçükşen, Yilmaz, Sallı & Uğurlu (2013). Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomized controlled trial with 1-year follow-up. Journal of American Osteopathic Association; 94(11), pp 2068–2074. Retrieved from http://www.archives-pmr.org/article/S0003-9993(13)00453-X/fulltext

Page, P. A new exercise for tennis elbow that works, 2010, North American Journal of Sports Physical Therapy. North American Journal of Sports Physical Therapy; 5(3), pp 189-193. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2971639/

Peterson, M., Butler, S., Eriksson, M., & Svärdsudd, K. (2014). A randomized controlled trial of eccentric vs. concentric graded exercise in chronic tennis elbow (lateral elbow tendinopathy): Clinical Rehabilitation; 9(1); pp. 862-872. Retrieved from http://journals.sagepub.com/doi/abs/10.1177/0269215514527595

Sevier, T, L., & Stegink-Jansen. C, W. (2015). Astym treatment vs. eccentric exercise for lateral elbow tendinopathy: a randomized controlled clinical trial. PeerJ, 3(1); pp. 1-26.  Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4451036/

Viswas R., Ramachandran, R., & Anantkumar, K. (2012). Comparison of Effectiveness of Supervised Exercise Program and Cyriax Physiotherapy in Patients with Tennis Elbow (Lateral Epicondylitis): A Randomized Clinical Trial. Scientific World Journal; 2012(1) pp1-8. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/22629225

Craig O'ConnorMotionPlus Osteo