What is tennis elbow?
Tennis elbow is the most common cause of pain on the outside of the elbow. It most commonly affects adults aged between 40-50 years. Although the condition involves gradual degeneration in the tendons on the outside of the elbow, it often occurs after a sudden episode of increased hand use where the tendons were overloaded. Symptoms include tenderness of the bone on the outside of the elbow (the lateral epicondyle) and pain with gripping and lifting. People with tennis elbow will notice significant loss of grip strength. The elbow can also feel stiff and become painful if it has been resting in one position for too long.
What causes tennis elbow?
The tendons involved in tennis elbow are those that extend our wrist and rotate our forearm. These muscles work hard to resist the weight of objects we hold in our hands. They are prone to degeneration due to a process called programmed cell death. The cells in our tendons (called tenocytes) have a certain number of times they can be replaced after a cell dies. Once this number is reached the tendon fails to generate new cells and degeneration
of the tendon begins to occur.
This process occurs in all tendons but is accelerated where our wrist muscles attach to the elbow due to the enormous demands that we place on these muscles. This huge demand results in faster cell turnover and the eventual degeneration of these tendons by age 40-50. Sometimes this can occur earlier or not at all depending on the demands on your hands from your job and other factors.
How is tennis elbow diagnosed?
Not all elbow pain is due to tennis elbow. It is important to get an accurate diagnosis to ensure you receive the right treatment. Pain on the outside of the forearm may be due to tennis elbow but it may also be due to compression of a nerve. Our hand therapists will perform a series of clinical tests to determine if you have tennis elbow or something else. Your doctor may also refer you for an ultrasound scan to examine the tendons at the elbow.
Tennis elbow treatment
Our hand therapists apply the latest research evidence to provide you with the most beneficial exercises to aid your recovery. An important part of recovery is knowing which actions to avoid to prevent further overloading of the affected tendons. Our therapists will help you to identify which actions to avoid to reduce pain and increase strength in the degenerated tendons. A tennis elbow strap, also known as a counter-force brace may be fitted to help reduce strain on the involved tendons. Our therapists also use a variety of other techniques to reduce pain and promote recovery including manual therapy techniques, taping, dry needling and electrical modalities. As with all overuse conditions, recovery is always better when treatment is commenced early.
A word on cortisone injection as a treatment for tennis elbow.
Corticosteroid injection is sometimes offered as a treatment for tennis elbow, however, there are a number of research studies which show that although the injections provides good short-term pain relief, long-term recovery is poorer, and recurrence is much higher than following a proper exercise program or no treatment at all. As a result, cortisone injections for this condition are increasingly going out of favour.