Clinical Corner

Next in the series of pathologies we will be exploring lateral epicondylitis or more commonly known as tennis elbow.

What is it?

Tennis elbow (lateral epicondylitis) is a common soft tissue condition that causes pain around the outside of the elbow and sometimes radiates upwards along the upper arm and downwards along the forearm. It is a tendinopathy meaning that it affects the forearm tendons attached to the elbow and develops due to overuse of the forearm muscles.

Cause

Some of the muscles (extensor muscles) that help to move our wrist and forearm attach via a tendon (most commonly the extensor carpi radialis tendon) to a common point at the outside of the elbow (lateral epicondyle). Overuse of the forearm muscles and tendons together with repetitive movement e.g. computer use, housework and sport or manual tasks e.g. heavy lifting, gardening and DIY can put too much strain on the elbow tendons. This then causes changes in the tendon structure resulting in micro trauma and pain at the outside of the elbow.  

Despite its name, only 5% of people suffering with tennis elbow relate the injury to tennis. It is more commonly seen in squash, badminton and field throwing events and in people with repetitive one-sided movements in their jobs such as electricians, carpenters and gardeners. Desk based jobs also commonly present with this condition.

Symptoms

• Onset of pain 24-72 hours after provocative activity.

• Localised pain over the tendon attachment on the outside of the elbow (lateral epicondyle) 

• Pain may also radiate upwards along the upper arm and downwards along the outside of the forearm. 

• Swelling can be present.

• Difficulty with lifting and gripping objects in the hand or when twisting your forearm such as opening a jar – pain +/- weakness.

• Stiffness on bending or straightening the elbow joint, particularly first thing in the morning.
  

Physiotherapy Management

• Advice for relieving pain includes rest, activity modification, ice compression and non steroidal anti-inflammatory drugs. Biomechanical factors may also need to be addressed e.g. new tennis racquet, training load, poor technique etc. 

• Epi clasp support (forearm orthosis) or tape can be applied to offload the forearm muscles during provocative activity and may reduce symptoms. 

• Modalities such as western acupuncture, soft tissue techniques, joint mobilisation and electrotherapy e.g. LASER can also be very effective.

• Specific progressive strengthening exercises of the forearm muscles have been shown in clinical research to have a positive effect. Addressing stability of the shoulder girdle is also a key component. 

• Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment that uses high energy shockwaves to stimulate the body's natural healing process. It has been proven effective in treating tennis elbow.

• Cortisone injection may be considered if conservative management has been ineffective.