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What is Tennis Elbow (Lateral Epicondylitis)

Tennis elbow is pain or discomfort localized over the bony prominence on the lateral (outside) aspect of the elbow. This is called the lateral epicondyle. The specific medical diagnosis for tennis elbow is referred to as lateral epicondylitis.

Symptoms can also be present on the medial (inside) aspect of the elbow however these are less common. When they do develop it is often referred to as golfers elbow.

Similarly, the medical diagnosis is medial epicondylitis.

Either problem is caused by excessive stress on the muscles that are attached into the epicondyles. In the case of tennis elbow these are the muscles extending along the top of the forearm and are involved with any activities of the wrist and fingers, such as gripping or typing.

The tensile stress causes micro tearing within the substance of the tendon with pain and inflammation resulting. The symptoms are generally most severe where the tendon inserts into the bone or where tendon portion joins the belly of the muscle also known as the musculotendinous junction.

When aggravated, the discomfort can radiate down the forearm and cause acute symptoms even with such minor activities like shaking hands, grasping a carton of milk, or opening a door.

No special equipment is needed to make the diagnosis for tennis elbow

A careful history and physical examination are all that is necessary. Palpation reproduces pain when pressure is applied to the outside of the elbow and increases when these muscles are made to contract. Many times there are trigger points, or knots, that have developed in the muscle and are responsible for much of the discomfort. There is frequently no specific incident as an obvious cause of injury. The initial symptoms are first noticed at either the beginning or end of an activity that requires wrist and elbow movement.

Rest alone generally decreases the symptoms but does not necessarily cure the problem. When the arm becomes active again the pain returns. The key to successful treatment is reducing the tissue irritation and progressing into a structured program of rehabilitation. Restoring normal tissue extensibility and decreasing the tightness of the local muscles is very important. Your therapist will provide an appropriate regimen of stretching and strengthening exercises to address these issues. Electrotherapeutic modalities such as ultrasound and electrical stimulation are also tools your therapist may use to assist your recovery. Needling techniques such as acupuncture, or Intramuscular Stimulation can be particularly effective as part of treatment.

Your cervical spine (neck) plays an important role in the function of your arms. The muscles of the arms are controlled by nerves in your neck. Problems with your neck that may not be overtly symptomatic themselves can interfere with how the nerves supply the muscles in the limbs. This altered function predisposes the forearm muscles and tendons to injury. Your therapist will evaluate the function of your neck and how the nerves are working to determine whether this is a component of your injury. They will then decide if treatment here is warranted as well.

As with other inflammatory ailments icing the forearm will assist in decreasing tissue irritation and relieve pain. Some find wearing a brace helpful. These are worn around the top of the forearm and function to alter the pull of the muscles inserting into the lateral epicondyle reducing pain. When symptoms are present during everyday activities the brace can be worn throughout the day.

In cases where conservative treatment does not adequately resolve the symptoms your doctor may recommend an injection of steroid. These are powerful anti-inflammatory agents that function to eliminate local tissue inflammation and pain. When properly done in the appropriate circumstances this can be a very effective treatment. Unfortunately, repeated injection weakens the connective tissue of the tendon which can lead to reinjury. Your doctor is the best to discuss fully the potential risks and benefits of this particular treatment.

Warm up properly before engaging in any demanding activity whether it is work or recreation. This includes stretching all of the key muscles. With racquet sports choosing appropriate equipment (such as grip size) is very important.

*** This information is not intended as a substitute for medical treatment. Before starting an exercise program, consult a physical therapist.

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