A Family Doctor's Tale - TENNIS ELBOW

DOC I HAVE TENNIS ELBOW

Tennis Elbow (also known as epicondylitis) is the inflammation and swelling of the tendon sheaths (called the synovium) and the enclosed tendons at the origin of the flexor muscles at the medial epicondyle or extensor muscles at the lateral epicondyle of the elbow.

The lateral epicondyle of the elbow is more commonly affected.


The cause of Tennis Elbow is unknown.

Some possible causes are:
1.Injury or trauma to the tendon-minor tears in the tendon attachment of these muscles are always present

2.Repetitive usage of extensor or flexor muscles of the forearm

3.Arthritis of the elbow joints may predispose to Tennis Elbow

4.Systemic diseases such as multiple sclerosis ,amyloidosis, rheumatoid arthritis

The symptoms and signs of Tennis Elbow are:

Onset is usually gradual.
Symptoms:
1.Pain on movement of the tendon of the muscles of elbow

2.Swelling of part of the tendon affected at the elbow joint

3.Stiffness of the tendon of the elbow - inability to stretch

4.Pain often radiates into the forearm

Signs:
1.swelling and pain localized at the epicodyle of the elbow

2.Rotation and grasping such as using a screwdriver or opening a jar aggravates the pain

3.There may be local tenderness of the inflammed tendon.

4.Extension or flexion of the hand against resistance can cause pain at the affected epicondyle of the elbow

5. X-ray s are usually normal although a traction spur may be present.

The complications of Tennis Elbow are:
Fibrosis and rupture of the inflammed tendon of the muscles of the elbow may occur leading to loss of function of the elbow.

The Treatment of Tennis Elbow is:

Conservative treatment:
1.rest of the tendon

2.Cold or ice may help reduce inflammation

3.Splints over the hand, wrist and elbow may help to rest the tendons

4.Pain killers such as NSAID(non-steroidal anti-inflammatory drugs) for pain

5.Muscle relaxant to relax muscles

6.injection of local anesthetic and long acting steroid into the affected area may help to reduce inflammation

7.Avoid overusage of the tendons and muscles of the elbow

Surgery :
Surgical reattachment of torn muscles of the elbow may be necessary if conservative treatment does not work.

The prognosis of Tennis Elbow is:
Prognosis is usually good although recurrence may occur after cortisone injection.

Surgery usually give excellent results.

The prevention of Tennis Elbow is:
1. Avoid any physical exercises such as tennis or golf which causes repetitative usages of the tendons and muscles of the elbow.

2.Avoid rotation or twisting movement of the muscles of the forearm which can cause minor tears of the tendons or muscles of the elbow.

A Family Doctor's Tale - TENNIS ELBOW

DOC I HAVE TENNIS ELBOW

Tennis Elbow or Lateral Epicondylitis is a common conditions in adults which is due to small tear in the tendons on the lateral or outside part of the elbow.

These tendons attach the forearm muscles to the lateral epicondle of the elbow.


Repeated tears tears leads to damage in the tendon a condition called angiofibroblastic hyperplasia.

The microtears and subsequent development of the damaged tissue is due to forceful or repeated use of the forearm muscles.

Recently it has also been called golf elbow.

In fact any repetitive forceful usage of the forearm muscle during work or sports can give to this condition.

Risk factors:
1.Age above 40

2.Activity - regular tennis of more than 2 hours playing per session or a similar activity such as golf

3.Technique - poor stroke technique in tennis or golf (hitting the ball with flexed muscle) and improper grip size

4.Other factors - over exertion of muscles

Symptoms:
1.pain and tenderness over the lateral part of the elbow joint

2.Pain is worse on resisted wrist and finger extension with elbow in full extension.

Diagnosis :
1.Diagnosis is based mainly of history and site of tenderness of the elbow

2.X-rays of elbow are done to evaluate the bone surrounding the muscles and exclude other causes of pain.

It may also reveal calcification of development of bone spurs of the lateral epicondylar region in chronic cases.

Treatment:
Conservative management with rest and observation for 6 months:
1.activity modification

2.correction of playing techniques in sports

3.improved ergonomic in work related usage of elbow

4.stretching exercises

5. counterforce bracing

6.pain killers and anti-inflammation drugs

7.Topical injection of steroid into the tendon

Surgery:
3 surgical options are:
1.open release of affected tendons with excision of damaged tissues

2.arthroscopic release

3.new techniques which improved blood supply to the affected area.

Prognosis:
Usually very good with injections or surgery

Prevention:
1.Adequate warm up exercise before strenuous activity to forearm

2.limit duration of play or activity

3.use correct technique