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Lateral Epicondylalgia (Tennis elbow)

Elbow pain affects people of all ages and may be associated with several different causes. Probably the most common sources of pain are the tendons that attach the muscles of the forearm to the elbow. This condition is sometimes known as ‘tennis elbow’ or ‘lateral epicondylitis’ but is more accurately termed ‘lateral epicondylalgia’.

Symptoms

Damage to these tendons causes pain around the outside of the elbow which may radiate into the top part of the forearm. In the acute stages there may be a constant dull ache in the area that is particularly bothersome at night, this is accompanied by sharper pain on some movements of the elbow and wrist. As the condition settles, pain becomes limited to certain actions such as lifting heavy objects, using a computer mouse, firm hand-grips, turning taps or door-knobs or particular sporting activities such as a backhand stroke in tennis.

In the initial stages, pain that is present at the start of an activity may ease with a few repetitions (warm up) and return again after cooling down. As the condition worsens pain will become increasingly more constant and intense and fail to ease with warm up.

How does it occur?

The lateral epicondyle is a the small bony prominence on the outside of the arm just above the elbow, this bump forms the attachment point for the tendons that run from the muscles of the forearm. Damage can result from a single incident that overloads the tissue, in which case sharp pain may accompany a tear in the fibres of the tendon. More commonly however, repeated wrist loading or extension movements (bending the wrist up) causes degeneration of the tendon which progressively worsens, eventually resulting in pain when the corresponding muscle is stretched or forcefully contracted.

Overuse or repetitive strain injuries usually results from an increase in the frequency of a movement or change in habits with respect to work or leisure activities. Examples might include an increase in computer work requiring use of a mouse, beginning a course of sewing or knitting, extra tennis/squash training sessions, laying bricks or pavers or a change in workplace set-up.

Management

The pain is an indication that damaged fibres of the tendon are being stressed, therefore it is important that painful activities are restricted as much as possible in order to allow tissue healing. In the initial stages of management, rest from aggravating activities unloads the tendon and may be combined with techniques such as ice, massage and taping or bracing. In rare cases your physiotherapist may recommend you speak to a GP or Pharmacist about taking a short course of antiinflammatories.

Joint mobilisation techniques may be used to ensure optimum biomechanics around the elbow joint, stretches and soft tissue therapy will help break down scar tissue and rehabilitate the damaged tendon. As pain settles you will be given specific strengthening exercises or sports phyiotherapy techniques designed to gently load the tendon in a controlled manner and build strength to the required level.

What to expect

You will have to decrease, or if possible avoid activities that cause pain in order to reduce the stress on the damaged tendon. The duration of this rest period varies according to how long you have been experiencing the symptoms and how easily they are provoked. During this period you may also be given a brace to reduce the pain associated with some tasks. The nature of tendon injuries are that they heal at a slower rate than other tissues, complete rehabilitation of degenerated tissue will take 4-12 weeks depending on severity. Return to pre-injury function needs to be progressed carefully and time periods will depend on condition severity and the nature of your sport or activities.

Physiotherapy Tips

  1. Discontinue painful activities to allow symptoms to settle.
  2. Tape or brace as directed.
  3. Perform the stretches and exercises as directed by your Physio.
  4. Carefully plan a progressive return to sport.

Other sources of elbow pain

  1. Medial epicondylalgia.
  2. Referred pain from the cervical or upper thoracic spine.
  3. Neural tension or nerve entrapment.
  4. Joint sprain or trauma.