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Tennis Elbow

What is lateral epicondylitis also known as tennis elbow?

Lateral epicondylitis is the sensation of localized pain and inflammation at the lateral aspect of the elbow, on the thumb side of the forearm. Oftentimes lateral epicondylitis is an overuse injury and is synonymous with the term “tennis elbow.” Repetitive wrist and elbow movements can increase discomfort at the outside of the elbow and forearm when one is experiencing lateral epicondylitis.

How does tennis elbow occur?

Repetitive elbow and wrist movements can cause lateral elbow pain. Continued upper extremity overuse without modification of movements or professional intervention can cause lateral elbow and forearm inflammation to intensify. Repeated “backhand” movements during tennis or hockey can increase lateral elbow symptoms. Rotational wrist and elbow movements during swimming and throwing can lead to lateral elbow pain as well. Excessively pulling weeds while gardening or landscaping can also cause symptoms to arise. Lateral epicondylitis can be seen in machinists, occupations that operate joysticks, overhead throwing and rotational athletes, and occupations that require repeated and prolonged keyboard typing. Ironically, baseball players can experience lateral epicondylitis, “tennis elbow,” from repeatedly throwing curveballs without adequate upper extremity strength or stability. Even physical therapist can experience lateral elbow pain from performing manual therapy techniques throughout the day.

What anatomical structures are involved in tennis elbow?

The lateral epicondyle is the bony point on the outside of the elbow, on the thumb side while the palm of the hand is facing away from the body. This anatomical region is on the opposite side of the ulnar collateral ligament, or “Tommy John,” ligament. Tendons attach muscles to bones, and several muscles that extend and rotate the wrist originate at the lateral epicondyle, along with the radial collateral ligament. The tendons of these muscles become inflamed and painful, which causes lateral epicondylitis symptoms. Muscular tightness at the outside of the elbow to the mid-forearm can be noted in those experiencing symptoms. Evidence suggests that a wrist extensor muscle termed extensor carpi radialis brevis becomes aggravated with lateral epicondylitis, and contraction or stretching of this muscle can cause symptoms to magnify.

What are signs and symptoms of tennis elbow?

Localized tenderness to touch at the outside of the elbow, near the bony point or tendinous region below. Pain with repeated wrist movements, especially with extending the wrist to pull weeds or perform a “backhand” athletic movement. Lateral elbow pain with prolonged or repeated gripping, holding a pencil while writing, opening tight jars, turning a doorknob, throwing curveballs, or swimming. Decreased grip strength or pain with grip testing may exist as well. Physical therapists can perform evidence-based special testing to confirm lateral epicondylitis involvement during the evaluation process.

How is tennis elbow treated?

People experiencing lateral elbow pain that is bothersome and interferes with work, hobbies, or daily activities should reach out to their primary care physician, orthopedic doctor, or physical therapist to receive formal treatment and become independent in a home-exercise program. The goal of physical therapy is to decrease symptoms and promote independence in symptom management so that one can return to doing the things they love without worrying about lateral elbow pain. Rest and ice are often the first step in decreasing symptoms of lateral epicondylitis, along with therapeutic exercise and other physical therapy modalities such as electrical stimulation. Evidence suggests that isometric and eccentric wrist exercises can promote tendon remodeling and decrease lateral elbow symptoms overtime. Manual therapy techniques such as soft tissue mobilization, trigger point release, joint mobilization, and scrapping are deployed by Physical Therapists to increase forearm tissue extensibility and promote adequate movement. Shoulder and thoracic spine mobility and stability drills are also used to address lateral elbow pain and to ensure that the entire chain in functioning properly. Lastly, workplace ergonomics may need to be addressed to accentuate the rehabilitation process, and bracing with a forearm strap can provide some relief of symptoms while on the job. Ultimately, people experiencing lateral elbow pain stemming from lateral epicondylitis should receive formal physical therapy to understand their diagnosis and prognosis.

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