Tennis Elbow, also known as lateral epicondylitis, is a condition characterized by pain and tenderness on the outside of the elbow. It’s a type of tendinopathy that affects the tendons attached to the lateral epicondyle of the elbow, usually as a result of overuse or repetitive strain.
Causes of Tennis Elbow
- Repetitive Strain: Often associated with activities requiring repetitive wrist extension or forearm supination, like playing tennis.
- Manual Work: Activities involving heavy lifting, painting, or use of tools.
- Age: Common in adults aged 30-50.
- Poor Technique: In sports or occupational activities, leading to overuse of the lateral elbow tendons.
- Previous Elbow Injury: May predispose to developing tennis elbow.
Diagnosis
- History
- Symptoms: Pain and tenderness around the outside of the elbow, worsening with gripping or lifting activities.
- Onset: Usually gradual onset associated with activities involving repetitive wrist extension.
- Occupation and Activities: Jobs or hobbies that could contribute to symptoms.
- Physical Examination
- Palpation: Tenderness over the lateral epicondyle.
- Cozen’s Test: Pain on resisted wrist extension.
- Mill’s Test: Pain on passive wrist flexion with an extended elbow.
- Range of Motion and Strength Testing: Assessing for any limitations or pain during movement.
- Investigations
- Imaging: Usually not necessary for diagnosis but can be used to rule out other conditions. X-rays can rule out arthritis; MRI or ultrasound can assess tendon damage.
Differential Diagnosis (DDx)
- Radial Tunnel Syndrome: A nerve entrapment causing pain in a similar area.
- Osteoarthritis: Joint degeneration, usually with a different pain pattern.
- Elbow Joint Pathologies: Like synovitis or capsulitis.
- Referred Pain: From neck or shoulder conditions.
- Bursitis: Inflammation of bursa near the elbow joint.
Management of Tennis Elbow
- Conservative Treatment:
- Rest and Activity Modification: Avoidance of aggravating activities.
- Ice Packs: To reduce pain and swelling.
- Pain Management: NSAIDs (e.g., ibuprofen) for pain relief.
- Bracing or Strapping: An elbow strap to reduce tendon strain.
- Physiotherapy: Strengthening and stretching exercises; modalities like ultrasound or laser therapy.
- Stretching Exercises: For the wrist extensor muscles.
- Strengthening Exercises: Gradually increasing load on the tendons to build strength.
- Injection Therapies:
- Corticosteroid Injections: Can provide short-term pain relief but not typically recommended for long-term treatment.
- Platelet-Rich Plasma (PRP) Injections: Emerging treatment with variable evidence.
- Surgery:
- Considered in cases where conservative management has failed for 6-12 months. Surgical options involve removing degenerated tissue from the tendon.
- Follow-up and Monitoring:
- Regular review to assess progress and modify treatment as needed.
Conclusion
Tennis Elbow is typically a self-limiting condition and can be effectively managed with a combination of rest, activity modification, physiotherapy, and pain management. Most cases respond to conservative treatment, but a small percentage may require surgical intervention. Patient education on ergonomics and exercise regimens is crucial for managing symptoms and preventing recurrence.