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What is Tennis Elbow?

Tennis Elbow (Lateral Epicondylitis) is a condition causing pain and tenderness around the outer aspect of the elbow joint. It commonly affects people who play racquet sports (hence the name) or manual workers though can occur in any individual.

What causes Tennis Elbow?

Tennis elbow is an overuse condition affecting the common extensor tendon (this is the tendon that attaches the extensor muscles of the wrist to the outside of the elbow joint.) With the palm facing down, when contracted the extensor muscles are the muscles that pull the wrist up to 90 degrees. Degeneration within the tendon due to overuse results in microscopic tears causing the symptoms in tennis elbow. In chronic tennis elbow calcification can occur around the insertion of the tendon and, in a small number of cases, larger tears can occur. However for the vast majority of patients the condition is not serious and can be self-managed.

What are the symptoms of Tennis elbow?

The usual symptoms are pain located around the outer aspect of the elbow over the bony prominence called the lateral epicondyle. The pain is triggered by actions that extend the wrist eg lifting with the palm down, wringing out a dishcloth or pouring from a heavy jug/pan. A tender spot can usually be felt over the bone and just in front of it in the tendon itself.

How is it diagnosed?

Diagnosis is usually made from the patient’s history and a simple examination without the need for special investigations. Ultrasound or MRI scanning may be done if there is uncertainty about the diagnosis.

How can I prevent it?

  • If you are new to a sport or activity get expert advice. Poor technique or incorrect equipment will increase the risk of injury
  • DIY work is another common cause of tennis elbow, especially in those unaccustomed to physical activity. Try to break large jobs up into manageable amounts and spread them over a number of weeks. Avoid carrying out lots of repetitive actions or excessive lifting all in one go
  • After activity massage and stretching may help Good general posture and correct set up of work stations is important
  • Build up slowly if you are not accustomed to an activity. It takes time for the body to get used to new activity and tendons adapt more slowly than muscles due to their poorer blood supply, so pace yourself and if in doubt take advice from an experienced sports trainer
  • Before participating in strenuous activity ensure you warm up slowly

How can I manage my Tennis Elbow?

Most cases of tennis elbow can be self-managed with simple things such as modification of activities, simple exercises and if necessary, painkillers. In a small number of cases injections may be done around the tendon and occasionally, in unmanageable cases, surgery may be an option.

Simple advice

  • After physical activity, if the elbow feels sore try applying an ice pack for 15 mins every few hours
  • Stretching after activity
  • In racquet sports, try increasing the size of the grip by winding more tape on it
  • Specific physiotherapy exercises called ‘eccentric exercises’ can be beneficial to tennis below There is very good evidence for the use of specific exercises to treat tennis elbow. These exercises are called eccentric exercises and are simple and quick to do, and if done regular will on average result in a resolution of symptoms over eight to 12 weeks.
  • Seated in a chair, support the forearm over the edge of a table or over your knee and hold the weight in the hand with the palm facing down From a position with the wrist fully extended (cocked back at 90 degrees) slowly lower the weight until the wrist is fully bent (flexed). Repeat this movement to complete 10-15 repetitions
  • After 10-15 repetitions rest for two minutes then do a further 15 reps. Rest again for two minutes then do a final 15 repetitions
  • It might be helpful to do some stretching and massage with anti-inflammatory gel after you do the exercise The tendon may feel sore and tender during or immediately after the exercises but don’t worry this is to be expected and should gradually improve as the exercises start to work Remember you will not notice immediate results. It takes eight to 12 weeks on average to fully rehabilitate the tendon.
  • Massaging the elbow may help and using a topical non-steroidal anti-inflammatory gel such as ibuprofen gel may reduce the discomfort
  • Modification of activity e.g. reduce the frequency or intensity of any activity that causes your elbow pain, or take a complete rest from it
  • You can buy braces specifically made to ease tennis elbow symptoms from sports shops or online. These put pressure on the tendon and muscles, helping to reduce symptoms when active
  • A dumbbell is perfect for these exercises, but any weight can be used, as can the rubber exercise/physiotherapy bands available online or from sports shops. The weight or strength of elastic band should be such that after the exercises, the forearm feels tired, but not so heavy that the exercises cannot be completed or are excessively strenuous.
  • The important movement is the lowering of the weight slowly from full extension to full flexion. It’s ok to use the other hand to help lift the weight back up again. This might be necessary in the early day when the elbow is still very uncomfortable
  • Do 3 x sets of 10-15 repetitions, twice daily

What are the symptoms of Tennis elbow?

  • Historically, corticosteroid (cortisone) injections have been done for tennis elbow. This involves a steroid being injected around the tendon and its insertion onto the bone However, some studies have suggested that patients who have injections have a poorer outcome long term, with ongoing or recurrent symptoms being more likely. Steroid injections also have potential complications of tendon rupture and atrophy of the tissue resulting in permanent dimpling of the skin around the injection site.
  • In a small number of severe, chronic cases surgery may be necessary. The surgery is aimed at releasing strain on the tendon, removing degenerative tissue and promoting healing

What is Golfer’s Elbow?

Golfer’s Elbow (Medial Epicondylitis) is a condition causing pain and tenderness around the inner aspect of the elbow joint. It commonly affects people who play golf (hence the name) and sports that involve throwing, such as cricket and baseball, climbing or manual workers. However, it can occur in any individual.

What causes Golfer’s Elbow?

Golfer’s elbow is an overuse condition affecting the common flexor tendon (this is the tendon that attaches the flexor muscles of the forearm to the inner side of the elbow joint) The flexor muscles are the muscles that curl up the fingers, which, when contracted, allow you to grip. Degeneration within the tendon due to overuse results in microscopic tears, causing the symptoms of golfer’s elbow. In chronic golfer’s elbow calcification can occur around the insertion of the tendon and, in a small number of cases larger tears can occur. However for the vast majority of patients the condition is not serious and can be self-managed.

What are the symptoms of Golfer’s Elbow?

The most common symptom is pain around the inner aspect of the elbow, over the bony prominence called the ‘medial epicondyle’. The pain is triggered by actions that require gripping e.g. lifting with the palm up, squeezing or pulling. A tender spot can usually be felt over the bone and just in front of it in the tendon itself.

How is Golfer’s Elbow Diagnosed?

Diagnosis is usually made from the patient’s history and a simple examination without the need for special investigations. Ultrasound or MRI scanning may be done if there is uncertainty about the diagnosis.

How can I prevent it?

  • If you are new to a sport or activity get expert advice. Poor technique or incorrect equipment will increase the risk of injury
  • DIY work is another common cause of golfer’s elbow, especially in those unaccustomed to physical activity. Try to break large jobs up into manageable amounts and spread them over a number of weeks. Avoid lots of repetitive actions or excessive lifting all in one go
  • After activity, massage and stretching may help
  • Build up slowly if you are not accustomed to an activity. It takes time for the body to get used to new activity and tendons adapt more slowly than muscles due to their poorer blood supply so pace yourself. If in doubt take advice from an experienced sports trainer
  • Before participating in strenuous activity ensure you warm up slowly
  • Good general posture and correct set up of work stations is important

How can I manage Golfer’s Elbow?

Most cases of golfer’s elbow can be self-managed with simple things such as modification of activities, simple exercises and if necessary, painkillers. In a small number of cases injections may be done around the tendon insertion and occasionally in unmanageable cases, surgery may be an option.

Simple advice:

  • After physical activity, if the elbow feels sore try applying an ice pack for 15 mins every few hours
  • Modification of activity e.g. reduce the frequency or intensity of any activity that causes your elbow pain, or take a complete rest from it
  • You can buy braces specifically made to ease tennis elbow symptoms from sports shops or online. These put pressure on the tendon and muscles, helping to reduce symptoms when active
  • A dumbbell is perfect for these exercises, but any weight can be used, as can the rubber exercise/physiotherapy bands available online or from sports shops. The weight or strength of elastic band should be such that after the exercises, the forearm feels tired, but not so heavy that the exercises cannot be completed or are excessively strenuous.
  • The important movement is the lowering of the weight slowly from full extension to full flexion. It’s ok to use the other hand to help lift the weight back up again. This might be necessary in the early day when the elbow is still very uncomfortable
  • Do 3 x sets of 10-15 repetitions, twice daily
  • Massaging the elbow may help and using a topical non-steroidal anti-inflammatory gel such as ibuprofen gel may reduce the discomfort Stretching after activity
  • In racquet sports, try increasing the size of the grip by winding more tape on it
  • Specific physiotherapy exercises called ‘eccentric exercises’ can be beneficial to tennis below There is very good evidence for the use of specific exercises to treat tennis elbow. These exercises are called eccentric exercises and are simple and quick to do, and if done regular will on average result in a resolution of symptoms over eight to 12 weeks.
  • Seated in a chair, support the forearm over the edge of a table or over your knee and hold the weight in the hand with the palm facing down From a position with the wrist fully extended (cocked back at 90 degrees) slowly lower the weight until the wrist is fully bent (flexed). Repeat this movement to complete 10-15 repetitions
  • After 10-15 repetitions rest for two minutes then do a further 15 reps. Rest again for two minutes then do a final 15 repetitions
  • It might be helpful to do some stretching and massage with anti-inflammatory gel after you do the exercise The tendon may feel sore and tender during or immediately after the exercises but don’t worry this is to be expected and should gradually improve as the exercises start to work Remember you will not notice immediate results. It takes eight to 12 weeks on average to fully rehabilitate the tendon.

Further Treatment

  • Historically, corticosteroid (cortisone) injections have been used to treat golfer’s elbow. This involves a steroid being injected around the tendon and its insertion onto the bone However, some studies have suggested that patients who have injections have a poorer outcome long term, with ongoing or recurrent symptoms being more likely. Steroid injections also have potential complications of tendon rupture and atrophy of the tissue resulting in permanent dimpling of the skin around the injection site
  • In a small number of severe, chronic cases surgery may be necessary. The surgery is aimed at releasing strain on the tendon, removing degenerative tissue and promoting healing
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