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Tennis Elbow without the Tennis

Did you know that you don't have to play tennis in order to get tennis elbow?


What is it?
Anatomy of elbow

Lateral epicondylopathy or formally known as lateral epicondylitis, is a painful irritation of the wrist extensor muscles which originates on the lateral epicondyle of the elbow--(the outside of the elbow bone). Lateral epicondylopathy (LE) is the most common cause of elbow pain. This occurs when the wrist is repeatedly put into extension and the forearm is twisting from supination (palm up) to pronation (palm down). LE is a byproduct of excessive force or repetitive movement, combined with improper biomechanics and/or posture. LE is commonly referred to as “tennis elbow”.


The most common wrist extensor (the muscle that puts the wrist into extension) is called the extensor carpi radialis brevis, which is hypovascular (lacking blood flow), creating an increased likelihood of injury. It is also hypoxic which increases the probability of degeneration in the muscle or tendon.


LE occurs when the wrist is in repetitive extension causing micro-tearing of the common extensor tendon, ultimately leading to a failure in the healing process and causing degeneration. A degeneration of the tendon may lead to a full tear due to the ongoing stress to the tendon, especially if you were to rapidly overload the tendon.

While acute inflammation may occur in the early stages of tendon disease, it usually does not last past a few days. In chronic cases, inflammation (swelling) is absent.


Certain occupations and activities put you more at risk which include carpenters, bricklayers, seamstresses, tailors, pianists, drummers, those who shake hands a lot, and those who perform prolonged keyboard or mouse work. LE results in an average of 12 weeks disability in up to 30 percent of those workers affected.


Those who have hypercholesterolemia or someone who smokes are at risk for lateral epicondylopathy because these conditions will help with the degeneration process because of lack of blood flow.


Even though only 5 percent of those with LE are racquet sport participants, among tennis players 50-60 percent of them will be affected at some point in their careers. Tennis players that are using new, heavy, or tightly strung racquets, excessive grip size, and hitting wet or heavy tennis balls are more at risk. Also, players with poor mechanics during a back swing or serve are exposing themselves to LE.


Symptoms

Symptoms usually begin slowly following an overuse-type activity, without any specific trauma. Pain is located over the lateral (outside) side of the elbow. Symptoms typically arise by activities that involve gripping and/or wrist extension. Pain can range from mild to severe and sharp which will limit simple activities such as picking up a cup. Rest in early stages may provide some relief.


The classic clinical findings of lateral epicondylopathy include pain when touching the lateral side of the elbow, pain with resisted (pushing against something pushing the opposite way) wrist extension, and pain with resisted middle finger extension. Those affected will also begin to have issues with wrist flexion and shoulder internal rotation as well. Grip strength may diminish, particularly with the elbow straight versus bent.


Diagnosis

A trial of conservative care is recommended! Radiography is of little use when diagnosing soft tissue disorders, so in this case they would not be helpful. Tendinopathy is usually diagnosed through clinical findings, and imaging should only be sought out for special circumstances. An MRI may show some tendinosis as well as bony or soft tissue pathology that is associated with LE.


Management

Twenty percent of untreated patients demonstrate no improvement after one year. Patients that are undergoing optimal management may require three to four months until full recovery. Evidence is pointing towards traditional conservative measures including manipulation, mobilization, exercise, friction massage, some bracing, and modalities.