Tennis Elbow (Lateral Epicondylitis)

Tennis Elbow is also known as Lateral epicondylitis it is one of the most common overuse syndromes, affecting both men and women equally. It occurs at an age of 40 years or older with a history of repetitive activity during work or recreation. It often occurs with activities such as racket sports and golf. Repetitive wrist extension with supination and pronation can cause excessive use of the extensor tendons of the forearm and also subsequent micro tears, degeneration of collagen fibers, and angiofibroblastic proliferation. If untreated, lateral epicondylitis persists for a period of six to 24 months.

Tennis Elbow Causes: 

Overuse – The extensor Carpi radialis Brevis (ECRB) is a muscle that acts as a wrist stabilizer in the extended position of the elbow. When the extensor carpi radialis brevis becomes weak from overuse, microscopic tears occur in the tendon where it is attached to the lateral epicondyle of the humerus. This will lead to pain and inflammation at the elbow.

Unknown – Tennis elbow or lateral epicondylitis can occur without any repetitive injury. The occurrence of this condition due to an unknown cause is called insidious 

Hypovascularity: as this region contains hypovascular areas, the tendinous unit will be unable to respond to repetitive forces that are transmitted from the muscle which results in decreased functional tolerance.

Symptoms of Lateral Epicondylitis:

• Weakness in grip strength or difficulty in carrying objects with hand, especially with the elbow extended.
• Occupation or activity which causes pain at the lateral side of the elbow.
• Pain and tenderness are just distal to or over the lateral epicondyle.

Risk Factors of Tennis Elbow:

• Sports: playing sports such as rackets may increase the risk of tennis elbow.
• Age: this condition might affect individuals of all ages, especially in the ages between 30 and 50 
• Occupation: Work that involves repetitive movements of the arm and wrist is more likely to land up with a tennis elbow. Occupations such as painters, carpenters, butchers, etc can have tennis elbows.

Lateral Epicondylitis Treatment:

• Cryotherapy: regular cryotherapy or icing over the affected area may help in reducing inflammation and pain.
• Patient education on the control of pain and modification of activities.
• NSAIDs – Topical NSAIDs may provide pain relief which might be short-term.
• Local corticosteroid injection has short-term (two to six weeks) effects on pain reduction, global improvement, and strength in the grip.
• ORTHOSES – Use of a proximal strap for the forearm may reduce pain and increase the strength of the grip maybe after three weeks. Bracing for up to six weeks may improve the individual’s ability to perform daily activities.
• Mobilization – Deep transverse friction massage is thought to realign abnormal collagen fiber structure, break up adhesions and scar tissue, and increase healing with hyperemia.

Physical Therapy 

• Physical therapy modalities such as laser and iontophoresis, ultrasound, and transcutaneous electrical nerve stimulation (TENS) are also often employed to treat lateral epicondylitis.
• Physical therapy exercise regimens, including strength training and stretching, are commonly used to treat lateral epicondylitis. Evidence suggests that exercise programs can reduce pain, and also improve grip strength.

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