Tennis Elbow or Lateral Humeral Epicondylitis

Tennis ElbowWhat is Tennis Elbow or Lateral Humeral Epicondylitis? Tennis is a popular sports played by people of all ages. However, some players can get medical problem in the elbow region. Injury also occurs in racket sports such as badminton, table tennis, golf and squash. Those who are on jobs that require repetitive, one-sided movements (example electricians, carpenters) or leisure activities (example needlework, knitting, gardening).are also prone to this problem.

The Facts of Tennis Elbow

Causes of Lateral Humeral Epicondylitis or Tennis Elbow

Tennis elbow or lateral humeral epicondylitis is most common in tennis players 35–50 years of age. Players of this age group is characterized by a high activity level and often play tennis three times a week or more. Each tennis session lasts at least 30 minutes. It has been shown that 45% of the athletes who play tennis daily, or 20% of those who play twice a week, may at certain stages suffer from tennis elbow or lateral elbow tendinosis. Tennis playing frequency has a direct effect on pain.

The greater the incidence of pain when the player plays more frequently. Players of higher ability, those who play longer and practice more, would more commonly have a history of elbow pain.

Tennis players most likely to sustain lateral humeral epicondylitis are those who have demanding techniques and inadequate fitness levels. Faulty technique is one of the most common causes for tennis elbow, especially a faulty backhand. The serve may also be associated with elbow pain.

Pathology

The lateral epicondyle of the humerus forms a common origin for at least parts of all the extensors of the wrist and fingers. This problem represents a degenerative process that is secondary to tensile weakness, overuse fatigue and possibly avascular changes (poor circulation). There are usually no inflammatory cells present.

Symptoms and diagnosis

  • X-rays usually appears normal so diagnosis is made based on signs and symptoms. Pain or tenderness is often experienced when the tendon near where it attaches to the upper arm bone, over the outside of the elbow is pressed gently.
  • History of repetitive activity or overuse, such as playing tennis intensively at a training camp, or resuming playing after a period of little activity.
  • Pain affects mainly the lateral aspect of the elbow, but may radiate upwards along the upper arm and downwards along the outside of the forearm.
  • Weakness in the wrist causing difficulty in carrying out such simple movements as lifting a plate or a coffee cup
  • A distinct tender point is elicited by pressure or percussion over the lateral epicondyle.
  • When the hand is dorsiflexed at the wrist against resistance, pain occurs over the lateral epicondyle,
  • A positive middle finger test: there is pain over the lateral elbow when the middle finger is extended against resistance.
  • Accurate diagnosis of tendinosis includes an evaluation of the magnitude of pathological change, which is helpful as a prognostic predictor, as well as formulating the treatment protocol. The patient’s description of time and intensity of pain is the best guide to evaluation.
  • X-ray of the elbow can exclude a loose body in the joint or a fracture. Other possible diagnoses are rheumatic disorders, trapping of a nerve and radiating pain caused by degenerative changes in the spine region; the fifth and sixth cervical vertebrae.

 

Preventive measures

  • The most important preventive measure is applying correct playing and working techniques,
  • Sometimes a forearm brace or a heat retainer can be used as a means of dissipating the forces outwards before they reach the epicondyle.
  • Training in asymmetrical techniques should be avoided.

 

In tennis, the following points should be emphasized:

  • The player approaches the ball correctly using good footwork.
  • Using the method to hit correctly with the racket and at the right moment.
  • Every stroke should involve the shoulder and the whole body so that ‘braking’ does not occur when the ball is hit. The stroke should be followed through and the wrist should be firm.
  • In order to decrease the velocity of the ball, the court surface should be slow. Fast surfaces such as grass or concrete cause the ball to hit the racket with increased force, resulting in increased load on the player’s arm.
  • The balls should be light. Wet or dead balls become heavy.
  • Use only correct equipment. Select racket in accordance to the individual’s playing technique. Heavy racket causes greater load so use a light racket. Racket should be well-balanced and easy to handle, e.g. when making angled dropshots.
  • The stringing of the racket should not be too taut but should be individually adjusted. Rackets that are tightly strung increases the impact and tension forces. Loosen the racket strung if you’re troubled by tennis elbow. Gut strings give more resilience and less vibration than nylon ones.
  • Choose a racket that you can grip comfortably. A simple method of determining the appropriate size of grip is to measure the distance between the midline of the palm of hand and the tip of the middle finger; this distance should equal the grip’s circumference.
  • A large ‘sweet spot’ (center of percussion, the area of the racket face where minimal torsion occurs on impact) is probably an advantage. Hits outside this spot will increase torsion and unwanted forces and vibrations.

 

 

Treatment Options for Tennis Elbow

There are three phases in treatment:

  1. Acute inflammatory phase;
  2. A collagen and ground substance production phase; and
  3. A maturation and remodeling phase.

 

Doctor’s treatments include:

  • Anti-inflammatory medication,
  • Ultrasound treatment,
  • High-voltage galvanic stimulation,
  • Transcutaneous nerve stimulation.
  • Administer local steroid injections in persistent cases and if pain interferes with the exercise program.
  • Injections should be given subperiosteally to the extensor brevis origin. During the initial 24–28 hours, patient may experienced increased pain,
  • A steroid injection should be followed by 1–2 weeks’ rest and should not be repeated more than 2 times. Steroid injection seems to be effective for about 3 months, indicating that the patient must continue with the exercise program.
  • If chronic symptoms of tendinosis pain lasted for more than 6–12 months, the healing is considered failed,

 

Cure For Lateral Humeral Epicondylitis

A genuine tennis elbow often heals spontaneously and the prognosis is generally good. If the person continues to load his arm, then the symptoms can persist for anything from 2 weeks to 2 years.

Our doctor has to examine the patient, diagnose possible underlying causes, check for pain and tenderness and a series of other diagnosis before he can propose the most suitable treatment plan for speedy recovery. So make an appointment with us today. The sooner you start seeking consultation with our experienced doctor, the sooner you’ll get rid of tennis elbow.

 

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