Management of Tennis elbow

Dr Amresh Jamwal
Tennis elbow or lateral epicondylitis is a problem associated with tendons that attach the muscles of the wrist and fingers to the bone on the outside of the elbow. One or more of the tendons become painful, thickened or swollen and the discomfort can be felt into the forearm along the length of the muscles. Other structures that are close to the tendon may also be effected, such as the nerves or joints and the muscles that are attached to the tendons can become weakened. It may happen as a result of a sport injury or from repetitive wrist and hand movement in work such as keyboard work. However, it is thought to be an overuse problem and this refers both to how long and how hard the muscles are worked.
There is pain on the outside of the elbow ranging from mild discomfort to severe pain interfering with sleep. Gripping or twisting movements are often painful, and may be worse against resistance (weight) or when the arm is out straight. Repeated movements such as computer mouse/keyboard work, wringing washed clothes or tightening screw with scewdriver can often aggravate the condition. The outside of the elbow may be very tender to touch and some pain may be felt travelling down the forearm.
Treatment :
Treatment consists of :
* Pain killers and Anti-inflammatory tablets.
* Physiotherapy includes treatment to relieve pain, reduce inflammation and scar tissue and mobilize surrounding joints and nerves and exercises to re-strengthen the muscles. The physiotherapist may use a combination of manual techniques using his/her hands and electrotherapy treatments such as Ultrasound. Ice packs should be used before exercises to reduce pain. It is normal to feel aching, discomfort or stretching sensations while doing exercises. However, if intense and lasting pain is experienced (e.g more than 30 minutes) the exercises should be reduced by doing them less forcefully or less often. Certain exercises may be changed or added specifically according to the patient’s condition.
* Usually an injection of local anesthetic and steroid (Cortisone) may be given. Although it can be a painful procedure, injection can have a good effect.
* PRP injection. It is an experimental technique of injecting a selected portion of patient’s own blood back (a concentrated version of the naturally circulating healing factors) into the painful bit of the elbow. These injections have been proven to be effective in some studies.
* Surgery may be done as a last resort in patients who have persistently painful symptoms despite trying all other treatments. The operation can be performed open (with a cut on the side of the elbow) or by arthroscopy (keyhole). The area of tendon responsible for persisting pain is identified and released from its attachment to bone. When the procedure is performed by arthroscopy, any other problems inside the elbow can also be addressed at the same time. Following surgery, heavy, strenuous and repetitive tasks are avoided by 6 weeks.
Some useful tips :
* Resting the elbow between activity and stopping activities which aggravate symptoms is beneficial.
* Be aware of the amount of force that you use to grip things. Try and use the minimum amount of force to maintain contact.
* Never lift anything with the back of your hand showing, try to pick up ‘palm up’.
* Altering the grip size on objects you use may also have some beneficial effect. Often enlarging the grip helps and reducing the weight of rackets/tools etc is useful.
* If you are involved in a sport or hobby using repetitive movements, seek expert advice on your technique. A Physiotherapist will be able to give you advice on your movement patterns.
* Using a splint or brace may be helpful if the pain is very severe. Brace or splint helps to decrease the tension on the tendon. Place the brace just below the painful area (i.e 2 to 3 finger widths below the bony part of the elbow). Wear it when you are using your arm and take it off at night or while resting. Experiment with the brace in slightly different places, if it is going to work it normally makes an immediate difference. The best test for the ideal position is the gripping action.
The author is Consultant Physiotherapist at Trikuta Physiotherapy Clinic