Lateral epicondylitis is the most common cause of elbow pain, mainly resulting from repetitive gripping or wrist extension during activities. It is basically a result of degeneration of the local tendon at the elbow.
This is commonly associated with repetitive microtrauma from excessive gripping or wrist extension, radial deviation, and forearm supination. The extensor carpi radialis brevis (ECRB) is the most frequently affected muscle.
Although it was originally thought to be an inflammatory condition, histopathological studies have shown that there is an absence of inflammatory cells, and it is thought to be more due to a tendinosis, which is a degenerative process. Repeated strain on the tendon causes collagen deposition, and proliferation of fibrous tissue which become vulnerable to repetitive forces, which results in further tears.
It affects mainly middle-aged people, and it is almost always curable.
In most cases, it is not necessary to have any other investigation other than a physical examination. Together with thorough history taking, some specific tests that we use include: Cozen’s test and the Mill’s test.
Ultrasound is an efficient, noninvasive, and relatively cost-effective imaging method to confirm the diagnosis if needed.
Non-operative treatment is the priority and mainstay for most patients anbd includes the following:
The most important point is to respect the pain and have a temporary break from the activity that is causing the most aggravation. Lifting with the palm facing up (avoiding lifting things with the palm down) can assist in transferring the force away from the extensor tendon insertion.
Stretching and strengthening the forearm muscles form an important part of recovery. Specifically eccentric exercises are advised which involve stretching the musculotendinous unit with an applied load.
Counterforce braces are used to reduce the pain by pressing on the forearm extensor muscles and then inhibiting and spreading out the load on the ECRB, therefore facilitating self-repair. In the most severe cases we may fabricate a wrist brace during activities to limit wrist extension and thus the limiting the activity of the ECRB tendon, to give it time to heal.
If you are suffering from Tennis Elbow and would like it examined by one of our fully qualified therapists, please call us at Melbourne Hand Therapy today (03) 9899 8490 or leave an enquiry and we will get back to you as soon as possible.