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