Tennis Elbow: an insight into elbow pain.
you feel a slight twinge at the outside portion of the upper arm, near the
elbow, for this could be sign of tennis elbow or tendinitis of the lateral
epicondyle. This condition is caused by continual small strains and microscopic
tears of tissue near the elbow, resulting in inflammation and pain.
Specifically, the tendon and
the extensor carpi redialis muscle) that extend the
bending your hand back, as if you were to push against the wall, are affected.
It commonly occurs while playing tennis because of overextension of the wrist
during a backhand stroke. But you do not have to play tennis to develop tennis
elbow. You can cause lateral epicondylitis by wielding a hammer or other tool.
It is the repeated motion over time that eventually causes the injury. This is
why people who are in their forties and fifties are more likely to develop
Tennis Elbow Symptoms
Patients with tennis elbow experience pain on the outside of the elbow that is worsened by grasping objects and cocking back the wrist. The most common symptoms of tennis elbow are:
Pain over the outside of the elbow
Pain when lifting objects
Pain radiating down the forearm
The pain associated with tennis elbow usually has a gradual onset, but it
may also come on suddenly. Most patients with tennis elbow are between the ages
of 35 and 65 years old, and it affects about an equal number of men and women.
Tennis elbow occurs in the dominant arm in about 75 percent of people.
Therapeutic options for Tennis Elbow
Treatment starts with rest, ice, and gentle stretching. Using a forearm
(tennis elbow) band that slips around the upper forearm takes tension off of
the elbow and can reduce discomfort.
Pain can last from a few days to a few weeks. Occasionally,
anti-inflammatory medications such as ibuprofen and naproxen can be used. A
cortisone injection can be helpful in some cases, but should be reserved for
the persistent pain that last more than six weeks, and it must not be done
more than three times. There always is a risk of tendon rupture and
breakdown of surrounding tissues as a result of a cortisone injection. After
the inflammation subsides, heat,
massage, and ultrasound treatment by a physiotherapist can speed up the
After the pain is relieved, it is important to prevent future
recurrences of tennis elbow. This is first done by gently
muscles and tendons of the forearm.
Wrist flexion: Slowly pull back the fingers and wrist into an
extended position (like you would
push against a wall), then pull the
and back into a fully
flexed position. Each stretch
should last about 10
is repeated between 8 and 12
times, three to four times every
day. This stretch should not be painful. So if it hurts, don't do it!.
Another way to perform these two stretches is to place your hands
together, as if you are praying and elevate your elbows, then place the
back of your hands together, in front of your chest, flexing the wrist, and
raising your elbows. Hold these positions for 10 seconds and repeat 8 to 12
Wrist Extension: After two to three weeks, wrist exercises can be
started. You can do this by holding a light 3 to 5 pound dumbbell weight or
grabbing a can of soup with your forearm on a counter top and your wrist
dangling just over the edge of the counter. With your palm facing the floor
and your elbow bent at 90 degrees, extend the wrist while holding the weight
(or can) and repeat 10 to 15 times, increasing the number of repetitions as
you become stronger. Then turn your hand so it faces the ceiling. Holding
the weight, flex your wrist 10 to 15 times.
Finger Extension. Place a rubber band around all five finger tips.
Spread fingers 25 times, repeat 3 times. If resistance is not enough, add a
second rubber band or use a rubber band of greater thickness which will
provide more resistance.
Ball Squeeze. Place rubber ball or tennis ball in palm of hand, squeeze
25 times, repeat 3 times. If pain is reproduced squeeze a folded sponge or
piece of foam.
Forearm Pronation/Supination. Grasp hammer (wrench, or some similar
device) in hand with forearm supported. Rotate hand to palm down position,
return to start position (hammer perpendicular to floor), rotate to palm up
position, repeat. To increase or decrease resistance, by move hand farther
away or closer towards the head of the hammer.
For all of the exercises perform 10 repetitions 3-5 times a day. With all
exercises use pain as your guide - all exercises should be pain free.
When to progress. Begin with a 1 lb. weight and perform 3 sets of
10 repetitions. When this becomes
easy, work up to 15 repetitions. Increase the weight only when you can
complete 15 repetitions 3 times
without difficulty. The axiom "No Pain No Gain" does NOT apply
Surgery is considered a last resort and is done only if there is
persistent pain and loss of function that lasts at least six months to a year. A
common surgical procedure used for those with continued pain and disability
consists of removing the scar tissue from the tendon, smoothing the bone, and
reattaching the tendon. This is often done as an outpatient procedure. Recovery
takes about 8 to 12 weeks.
Non-surgical Treatment of Tennis Elbow
Rest- Avoid any activity that will overuse the
Ice the area just below and to the side of the
Compress your forearm with a support band, just
below the elbow.
Gently stretch the wrist.
Take anti-inflammatory medication and pain relieving
Physiotherapy treatment, including heat and /or
ultrasound therapy can aid rehabilitation.
Occasionally an injection of a cortisone (steroid)
can help (but never more than three injections).
Strengthen the muscles and tendons that move wrist
using light weights.
Employ smooth movement of the elbow.