Tennis Elbow Treatment Plan And Prognosis

Tennis elbow is a very common overuse injury that causes pain & inflammation of the tendons that connect the muscles of the forearm to the elbow.  It occurs as a result of the repetitive contraction of the muscles & tendons.

It is commonly seen in sports individuals playing tennis. You feel pain at the lateral epicondyle, the bony prominence on the outer side of the elbow. It can affect anyone but usually occurs in people age of 30 - 50 years. It is commonly involving your dominant arm.  It takes a long time to resolve & interfere with your daily activities.

Tennis Elbow Causes

Tennis elbow may be developed by a number of reasons. It can be caused by trauma, repetitive stress & overused injury to the lateral epicondyle. The following causes are responsible for tennis elbow -

• Any activities that requires excessive constant gripping or squeezing.(e.g. screw driving)
• Any repetitive movements of the wrist & arm muscles.
• Extended computer mouse usage.
• Weightlifting.
• Painting.
• Playing racquet sports with improper techniques.

Tennis Elbow Symptoms

The tennis elbow symptoms depending on the severity & extent of the condition.

• The usual symptom is an aching or burning pain over the outer side of your forearm & elbow joint that is worsened by gripping or lifting small objects with resistance.
• The pain may gradually spread down to your wrist, even at rest.
• You may also feel tight & sore at forearm muscles.
• You may have swelling around the affected part.
• Sleep disturbance is common.
• Weaken grip strength present.
• Pain is worse when you perform simple task such as turning a door knob or shaking hands.

Tennis Elbow Diagnosis

You should consult with your GP if the pain lasted a long time. Your doctors will diagnosis tennis elbow by medical history, physical examination & radiological test such as x-ray.

Medical history:   your doctor will first take a brief medical history by asking you  - about your painful feelings, how pain affects your regular activities & past injuries to your elbow.

Physical examination: It is often most helpful in diagnosing a tennis elbow. Your doctor will perform a thorough physical examination for the diagnosis of tennis elbow. The doctor will examine your elbow, arm & wrist joint to check where pain, swelling, and stiffness are located. Doctor may put pressure on the affected part to get the tenderness or may be asked to move your elbow gently in various directions.

Radiological test: in some cases,   your doctor may order an x-ray or MRI of  elbow. These tests help ensure you don’t have a fracture. The x-ray mostly helps your doctor rule out other problems with the elbow joint. MRI required for determining the extent of the injury.

Tennis Elbow Treatment

The best ways to treat tennis elbow are in a specific order, rest & support. Patients with tennis elbow are best treated by conservatively. Treatment depends upon the nature and extent of inflammation.

Relaxation: you will need a take a break from doing heavy activities as well as taking part in sports. You will stop the activities which causing pain.

In the acute stage, applying an ice pack to the affected elbow joint. It helps to reduce pain & limit damage to surrounding tissue. It should be used for 10-15 minutes, 2 times per day.

Elbow brace: wearing a special type of tennis elbow brace which acts to keep the forearm muscles from pulling on their attachment site on the epicondyle. It provides you an additional support of the joints by compression. It holds the tendons & ligaments in place so they don’t stretch. It will allow you to continue to work without stressing the joint.  You can protect the elbow from further damage by using it. It may help to limit painful activity temporarily but should not typically be used at all times. It applies pressure to the elbow tendon & helps to change the forces on the tendon.

Medication:  In the acute stage, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may give you some relief. These types of drugs can help decreasing pain. There are some risk factors. So it is important to consult with your doctor before beginning any medication.

If inflammation does not go away, your doctor may choose for corticosteroid injection to the elbow joint. Its benefit is temporary but it can last for a period of weeks to several months.

Physical therapy: Tennis elbow may be reduced to the maximum level with the help of physiotherapy. Physical therapist uses different types of exercises to strengthen & improve muscle tone that
supports the elbow joint. e.g.

• Range of motion exercise to increase flexibility & reducing stiffness.
• Soft tissue massage to the damaged area breaks down scar tissue & stimulates the production of more collagen through a combination of cell stimulus & collagen fiber cycling.
• Massage & stretching can improve tissue mobility.

Physiotherapist use a variety of treatment approach to treat Tennis elbow including -Ultrasound, Laser, Electrical stimulation, The Gastron technique, Massage, Exercise, Moist heat pack.

Physiotherapists advise some simple & effective eccentric exercise that you can do at home for comfort.

Mobilize stretch - tennis elbows are often caused due to muscle trigger points. Rhythmic stretching exercise can stimulate affected muscle groups.

• Sitting on the edge of a rigid chair.
• Keeping your hands palm down with your fingers pointing backward.
• Slightly lean into this position for increased intensity.
• Change position, keeping your dorsal part of hands down with your fingers pointing backward.

Wrist flexion: it works your flexors which also
connect into the elbow.

• Sitting in a chair, hold a 2-pound dumbbell with your palm facing upward.
• Elbow rest on your knee.
• Keep up your palm face-up; then flex your wrist curling to towards your body.
• Repeat 8 times for both sides.

Wrist extension: it works the muscles responsible
for your wrist bending.

• Sitting in a chair, holding a 2-pound dumbbell with your palm facing downward.
• Elbow rest on your knee.
• Extended your wrist curling it toward your body.
• Repeat 10 times on both sides.

Fist clench: it works to the strengthening of long flexor tendons in the fingers & thumb, you can improve your ability to perform the daily activity.

• Sitting in a chair, resting your forearm on a flat surface infront of you.
• Rolled - up towel or hold a small ball in your hand.
• Squeeze the towel / ball & hold for 5-10 sec.

Towel twist: it works for both groups of wrist flexors & extensors.

• Sitting in a straight backchair with relaxing your shoulder.
• Hold a towel with both hands.
• Twisting the towel in opposite direction.
• Repeat 10 times on both sides.

Shock wave therapy:  a special device allows the high energy sound waves to be passed through the skin around your elbow. It’s a newer form of non-surgical treatment. It appears to be safe. Patient generally receives the treatment once each week for up to 3 weeks. There is a small chance of side effects.

Surgery: if conservative treatments have not worked after 6 - 12 months, your surgeon may be recommended you undergo a surgical procedure to treat tennis elbow. Your surgeon will decide whether to perform your surgery in the traditional method or endoscopically. The common surgery to ease symptoms is to remove scar & degenerative tissue from the tendons.

Tennis Elbow Outlook / Prognosis

The best way to accomplish tennis elbow recovery is to offer proper rest & be carefully stopped aggravating activities. The prognosis of the tennis elbow is generally good. Most people feel better in as little as a couple of weeks but it may take 6 months to a year for the tendon full heal. Its full recovery is obtainable. Unfortunately, it may return.