What do we call tennis elbow?

With Wimbledon coming to a close, we are reminded of all the injuries associated with tennis. When we talk about tennis injuries, one of the most common one you can probably think of is tennis elbow. Tennis elbow (lateral elbow pain) often develops from overuse or over stress the tendon at the elbow, although it can also occur without a specific reason. It has kind of a misleading name because it does not have to happen from tennis (similar to golfer’s elbow). Less than 10% of the tennis elbow population obtained their tennis elbow problem from tennis.

These affected muscles are called wrist extensor carpi radialis longus and brevis, where their tendons are attached to the lateral side of the elbow. These muscles primarily extend wrist and facilitate gripping and fingers’ movement.

 Activities that involve repetitive wrist movements tend to be the main cause of tennis elbow e.g. dish washing, typing, using screw driver etc. The symptoms can be very disturbing as it can last from 6 months to 2 years, and recurrence is not uncommon.

 

Treatment

To date conservative treatment remains the preferred approach as most patients can recover from it either completely or make it manageable. These treatments include:

  • Joint mobilisation
  • Graded strengthening exercises (from eccentric alone to combined concentric and eccentric)
  • Stretches
  • Taping
  • Elbow braces
  • Ultrasound
  • Shockwave
  • Options for medication or invasive treatment include:
  • Dry needling
  • PRP injection
  • NSAIDs
  • Steroid injection
  • Surgery

There has been more supporting evidence that concludes better short term pain relieve and long term symptoms resolution through joint mobilisation and specific strengthening exercises. Evidence for ultrasound and shockwave has been inconsistent although some people find them beneficial. It was well known that steroid injection has superior results than conservative therapy for the first 6 weeks in terms of pain relief, but the long term outcome is poorer and the recurrence rate is higher. Surgery is rarely indicated, however it can be an option if other management strategies failed.

 

Differential Diagnosis

There are multiple structures that can present similar to tennis elbow. Tennis elbow itself can be the sole problem or these differential diagnoses can co-exist. That is why it is important to do a musculoskeletal screen for  these potential differential diagnoses before just repeating the same treatment. Below are some possible, but not limited to, differential diagnoses:

  • Proximal radio-ulnar joint dysfunction
  • Humeroulnar joint dysfunction
  • Wrist extensor muscle tear
  • C5, 6, 7 radiculopathy
  • Posterior interosseous nerve entrapment
  • C6 syndrome
  • T4 syndrome
  • Radial nerve neuro tension
  • Climber’s elbow (brachialis muscle)
  • Biceps dysfunction
  • Triceps dysfunction

 

If you have any questions regarding your elbow pain, or were interested in seeing if we can help you, feel free to give us a call.  Here at Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, as well as advice on the best course of action for your condition to get you back in action sooner than you could’ve imagined.  We have an expertise in musculoskeletal physiotherapy and are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Wahroonga, Westleigh, West Pennant Hills, and West Pymble. So give us a call on (02) 8411 2050 to get started on a journey to a better you. 

 

References

  1. http://link.springer.com/chapter/10.1007/978-1-4899-7534-8_2
  2. http://www.cochrane.org/CD003525/MUSKEL_surgery-for-elbow-pain-tennis-elbow
  3. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003686.pub2/abstract;jsessionid=17261B927963096F35CABF0BD242DF46.f03t03
  4. http://www.cochrane.org/CD001978/MUSKEL_corticosteroid-injections-for-tennis-elbow
  5. http://www.cochrane.org/CD003524/MUSKEL_shock-wave-therapy-for-elbow-pain
  6. http://www.cochrane.org/CD001821/MUSKEL_orthotic-devices-for-the-treatment-of-tennis-elbow
  7. https://www.researchgate.net/profile/Dimitrios_Stasinopoulos/publication/262066317_Are_there_Effective_Ultrasound_Parameters_in_the_Management_of_Lateral_Elbow_Tendinopathy_A_Systematic_Review_of_the_Literature/links/54db3aff0cf261ce15cf88b7.pdf
  8. http://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/2052-1847-6-12
  9. http://bjsm.bmj.com/content/early/2013/05/23/bjsports-2012-091990.short
  10. http://bjsm.bmj.com/content/48/12/952.short
  11. http://link.springer.com/chapter/10.1007/978-1-4899-7534-8_1

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