Tennis elbow

Woman with Tennis Elbow

 

Do you play a lot of tennis? Neither do most of the people who suffer from so-called Tennis Elbow, one of the more common upper extremity ailments I see. Tennis Elbow goes by several names, most commonly lateral epicondylitis after the lateral epicondyle to which the affected tissues attach. More recently, that term has been scrapped for lateral epicondylopathy. Having the -itis on the end suggests inflammation, something often not present with Tennis Elbow. Whatever it’s called, it can be positively debilitating.

Symptoms of Tennis Elbow include:

  • Pain over the outside of the elbow
  • Pain with gripping and certain movements, especially bending the wrist back and lifting
  • Pain can radiate from elbow to wrist
  • Often sufferers complain that it’s worst in the morning

 

Treatment of Tennis Elbow

Tennis Elbow is traditionally thought of as an overuse or repetitive stress injury. This is only partially true. It is true that these tissues are suffering from overuse and are getting repetitively stressed, but not necessarily by the gripping and wrist extending motions typically associated with the condition. As with most issues people have with their elbows, the problem usually isn’t in the elbow. Most elbow issues people have can be traced back to the shoulder and/or wrist. In the case of Tennis Elbow, it’s usually the shoulder. I’ll Explain.

When an instability exists in the shoulder, or any other joint for that matter, neighboring areas will often tighten in support. In the case of Tennis Elbow, a muscle called the extensor carpi radialis brevis is usually the one paying the steepest price. When I treat someone with Tennis Elbow, I of course treat the actual extensors as well as the underlying causes. The tissues around the lateral epicondyle are usually much too tight and often have become thickened with scar tissue. Additionally, the radial nerve can become entrapped and inflamed, compounding the symptoms. The underlying problems normally exist in the musculature of the glenohumeral joint (such as the notorious rotator cuff), the articulation between the shoulder blade and the rib cage, and in lack of proper thoracic spine mobility.

As I mentioned earlier, the proper name for Tennis Elbow was recently changed away from lateral epicondylitis to reflect the fact that inflammation need not be present. However, given enough time, inflammation often does set in. The condition becomes substantially more difficult to treat at this point. The inflammation can not only yield more scar tissue, but it can degrade the structural integrity of the common extensor tendon to which the muscles of the outer elbow attach. It can still be treated at this point, but will generally be a more gradual process.

 

Tennis Elbow Therapy

To summarize, Tennis Elbow is seldom just an elbow problem. It’s usually a multi-joint dysfunction featuring instability, soft-tissue scarring, potential nerve entrapments and sometimes including inflammation. Simply putting on an elbow brace and taking some NSAID’s will not solve your problem, even if they lessen or alleviate the symptoms. A comprehensive approach provided by your therapist of whichever stripe is advised and is necessary if one wants to be confident the condition won’t return.

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