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Congratulations to Jenny on successfully qualifying as a JEMS rehabilitation practitioner and in so doing joins an elite group of expert physiotherapists who use cutting edge techniques to rehabilitate their patients. Find out what makes JEMS unique

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tennis elbow

Definition

Lateral epicondylitis or lateral epicondylalgia, also known as tennis elbow, shooter's elbow or archer's elbow, is a condition where the outer part of the elbow (the part of the elbow on the same side as the thumb with your palm facing upwards) becomes sore and tender. It is commonly associated with playing tennis or other racquet sports, however this condition can be experienced by almost anyone whether they have played racquet sports or not.

Symptoms

The symptoms associated with tennis elbow include, radiating pain from the outside of the elbow, weakness of the forearm and acute pain when performing gripping or manual activities, even something as simple as putting a key in a lock or turning a handle.

Causes of tennis elbow

Tennis elbow is widely acknowledged as an overuse injury which affects the common extensor origin, or the outside of the elbow known anatomically as the lateral epicondyle. It is in this area that the muscles involved with gripping and extending or “cocking” the wrist are attached to the bone via their tendons. Many tennis players will be familiar with the term “cocking the wrist” which gives the hand a position of stability and strength while striking the ball. Indeed, any activity which uses a similar action of the hand such as pouring a jug of water can cause pain in this area of the elbow. It is also commonly experienced by people who perform repetitive manual tasks, such as builder’s, typists and factory workers for example.

Studies of tennis elbow have shown small tears in the tendons which attach to the bone in patients undergoing surgery, however not in all patients, indicating that not all cases are true tennis elbow. Also, small adhesions between the elbow joint and the radial nerve which passes close by have been observed during operative procedures. The nerves from the neck which supply the lateral elbow or (outside of the elbow) can also be a source of symptoms and pain, so it is not uncommon for people to be under the mistaken belief that they are suffering from tennis elbow, when in fact the symptoms are as a result of referred pain from a neck problem. If you are experiencing pain in both elbows, then you would be very unlucky to have tennis elbow affecting both elbows and investigation would be needed to rule out some other reason for your pain.

Treatment options

To begin with, the symptoms may get better over several weeks if aggravating activities are stopped and a short course of ante-inflammatory drugs (NSAIDS non-steroidal ante inflammatory drugs) are taken. You must seek the advice of your doctor first. Sometimes over time the pain gets worse and tablets do not relieve the pain. Persistent cases may benefit from a steroid injection, however this treatment is limited, as this can weaken the tendon if repeated injections are administered. Now is widely accepted that 2 or 3 injections is the maximum advised. Studies have shown that a course of physiotherapy involving joint mobilisation, nerve mobilisation, acupuncture, movement correction and exercise can reduce pain and improve gripping power, enabling a person to continue their desired activities.

A course of physiotherapy is advised as early as possible. First to correctly diagnose the source of the problems, secondly to prescribe the right treatment to alleviate symptoms and prevent deterioration of the condition, and thirdly to provide a plan for the patient to self manage and prevent worsening of the problem.