Elbow problems - tennis elbow

Tennis elbow is the common term for 'lateral epicondylitis'. Pain is felt on the outside of the elbow and can spread along the muscles which run from the outside of the elbow to the wrist. Less commonly, pain can be felt a short way above the elbow.
 
Tennis elbow is usually caused by changes in patterns of activity, involving heavy or repeated gripping pulling or lifting. It can also be caused by direct impact on the outside of the elbow. Over the years, tennis racquets have improved such that, with the development of topspin (less 'flat') shots, a greater proportion of these injuries are from something other than tennis.
Diagnosis is confirmed, when there is specific tenderness over the outer side of the elbow on the bony prominence known as the lateral epicondyle.  The tendon for the forearm extensor muscles attache to the bone here.
 
The tendon itself just below it's attachment can also cause pain, as can the junction between the tendon and muscle. These latter, are variations of tennis elbow and can be identified by experienced clinicians. Pain is worse with gripping and extending the fingers against resistance. There are a number of other conditions such as brachial neuritis (from the neck) and carpal tunnel syndrome (at the wrist) which can mimic, and be confused with, tennis elbow. These, and other less common causes should be excluded before assuming that the pain is a 'true tennis elbow'.
 
There are a number of different ways to treat tennis elbow. Clinicians can identify the best strategy for each patient, dependent on the severity and nature of the problem, as well as the lifestyle requirements of the patient:-
 
Hands on Osteopathic treatment - Involves soft tissue release of the extensor muscles, friction over the tendon to break down scarring and improve circulation. Manipulation of the joint between the elbow and forearm ( the radio-humeral joint) can also be helpful.
Andrew Gilmour and Felix Cory-Wright normally expect that patients will require 3-4 treatments to know whether this is working for them.
 
Needling - using acupuncture needles is a procedure called 'periosteal pecking'. The needle is used repeatedly to stimulate the tendon cells to produce more scar tissue for strengthening.
 
Tennis elbow strap - These straps can be helpful in minimising the effect of activity. There are a number available from www.physio_med.com and those with a gel pad tend to be most helpful. Experiment with the tension to find that which suits you best.
 
Exercises - There are a number of exercises which can help strengthen the muscles after an episode of tennis elbow. Stretches can reduce the 'pulling effect' on the tendon.
 
Local steroid injection - This is performed by a medical doctor. At Andrew Gilmour and Associates,  Dr Chris Rufford is a consultant in sports and exercise medicine and skilled in this technique.  It involves injecting the most tender point with local steroid and local anaesthetic. The steroid is intended to reduce inflammation, and the local anaesthetic to minimise pain from the procedure. You must be properly assessed in relation to any medication you are taking and your general health. Possible side effects are discussed, and as a general rule, no more than 3 injections are given for a particular episode. 
 
Surgical intervention - Generally surgery is not considered until all other treatments have been tried, but can be necessary in a small number of cases.
 
It may be that the first treatment approach is not the successful one. Treatment may be a process of elimination, to find the right approach for the individual ,or even a combination of modalities. Resolution of tennis elbow is rarely a quick fix and patients should be prepared to modify their habits as advised.
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