Lateral epicondylitis or tennis elbow happens when chronic microtrauma occurs to the extensors of the wrist or forearm. This for the name tennis elbow from the constant and repetitive backhand of a tennis player that may develop a painful elbow from constant sports play. This condition however does not affect only sports athletes, but can affect those in occupations like meat cutters, plumbers, and weavers.
Causes of tennis elbow.
The main cause would be repetitive overuse and often forceful wrist extension. Anyone who fits this bill in occupational or sports activity may have the condition show up at some point in their lifetime. it is thought to be an angiofibroblastic hyperplasia of the wrist extensors. This essentially meaning that chronic injury of these muscles leads to fibrotic tissue deposition that can lead to pain and disfunction. The muscles involved usually are the extensor carpi radialis brevis, extensor digitorum communis, or the extensor carpi radialis longus.
Lateral forearm musculature showing the commonly injured muscles in tennis elbow or lateral epicondylitis. Extensor carpi radialis brevis, extensor digitorum, extensor carpi radialis longus. Illustrated by Frank Netter Atlas of Human Anatomy 6th edition.
Treatment of lateral epicondylitis or tennis elbow.
In the acute phase, rest is essential. Slow stretching and isometric exercise may be beneficial. Using tennis elbow brace may be used to distrbute the pull of the muscles injured away from the muscular origin site, gining the site much needed rest.
Invasive corticosteroid injections may be useful in the short term but have worse outcomes for long term recovery when compared to physiotherapy. Short-term results of corticosteroid injection were 92%, physiotherapy at 47%, and the wait-and-see-approach at 32%. When looked at in long term effectiveness, corticosteroid injection 69%, physiotherapy 91%, and the wait-and-see-approach at 83% measured at one year.
Cross friction massage, myofascial release, and mobilization are also effective. The use of continuous ultrasound can be used to increase the bodies ability to remodel the damaged muscles. Interferential therapy can be done to aid in pain moduation. Treatment of this condition can be lengthy especially if not treated immediately, and activity modification is ignored. This can take anywhere from 6 months to 1 year.
Tenderness over the lateral epicondylitis seen in tennis elbow or lateral epicodylitis. Illustrated by Frank Netter. Netter’s Concise Orthopedic Atlas 2nd edition.
When to see a specialist.
Getting in to see a specialist like a chiropractic orthopedist can be the first step to treating the condition. It start with proper diagnosis and correct treatment formulation to aid in quick resolution. A detailed examination can help rule out other causes of elbow pain that may not actually be related to tennis elbow. Some of these conditions could be a protruding disc with referred pains to the arm and elbow, joint irritation in the neck that refers pain into the elbow, or even a trigger point in the neck musculature that cause elbow pain referral. All of these conditions will be evaluated by your specialist.
The treatment available to the chiropractic orthopedist include all of the above mentioned treatment of ultrasound, interferential TENS, myofascial release, friction massage, and instrument assisted soft tissue mobilization. Also at the specialists disposal are xrays and advanced imaging like MRI if necessary.
Conservative treatment of a condition like tennis elbow should be the first line of treatment. This always begins with thorough evaluation and diagnosis. If you are suffering form elbow pain don’t wait, see one of our specialists today. Call 540 898 4100 or vist us here!
