...less medical jargon in a 'Quick Glance' format!
Epicondylitis is an inflammation or damage to the area of an epicondyle of bone. An epicondyle is a projection of bone above a rounded prominence at the end of a bone, usually where the bone connects to another bone where ligaments and tendons are attached. Two common types are tennis elbow and golfer's elbow. Tennis elbow is also known as lateral epicondylitis, which is an overuse injury to the area of the outside epicondyle of the elbow end of the upper arm bone. Golfer's elbow is an overuse injury similar to tennis elbow, but in this case the damage occurs in the area of the medial epicondyle of the upper arm bone.
Symptoms:
Pain about 1-2 cm down from bony area at the outside of the elbow
Weakness in the wrist with difficulty doing simple tasks such as opening a door handle or shaking hands with someone.
Pain on the outside of the elbow when the hand is bent back at the wrist against resistance.
Pain on the outside of the elbow when trying to straighten the fingers against resistance.
Pain when pressing just below the lateral epicondyle on the outside of the elbow.
Causes:
Tennis elbow is often caused by overuse or repetitive strain caused by repeated extension (bending back) of the wrist against resistance. This may be from activities such as tennis, badminton or squash but equally from activities such as brick laying, excessive use of a screwdriver and computer typing.
A poor backhand technique in racket sports can be a cause. This is commonly seen in players who arrive late for a backhand meaning that they cannot get their body behind the ball. They play the shot with a limp or bent wrist instead of a firm wrist and are not using the strength of the whole arm or the twisting movement of the trunk.
This means that the wrist has to compensate and in doing so injuries are caused to muscles and tendons around the elbow. The wrist should be firm and not bent when the ball is struck so the forces can be spread over the arm, shoulder and the rest of the body. If you imagine a ball traveling at 70mph and hitting the end of a long lever made up of your arm and the tennis racket then all that force is focused on the tiny insertion of the tendon of the lateral epicondyle causing tennis elbow symptoms.
Another problem can be a racket grip that is too small. A small grip will mean the muscles in the elbow must work a lot harder leading to structural changes in the tendon. The majority of people with tennis elbow are between 40 and 50 yrs but it can affect athletes of any age.
Treatment:
No single treatment for Epicondylitis has been shown to be totally effective, however a combination of the treatments below are known to resolve tennis elbow over time. Each individual will react differently to different treatments.
. . . What can the athlete do?
Apply ice or cold therapy to the elbow 20 min's on up to six times a day. This will help reduce pain and inflammation if present.
Rest - an extremely important component in the healing of this injury.
Wear a brace or support to protect the tendon whilst healing and strengthening, particularly when returning to playing / equivalent. The brace should not be put on the painful area but rather approximately 10cm down the forearm.
As with all soft tissue injuries a comprehensive rehabilitation program should be carried out.
. . . What can a sports injury specialist or doctor do?
Correctly diagnose the condition: This may be done by carrying out Mills' test - resisted wrist extension with the palm facing the floor and moving the hand sideways in the direction of the thumb. If pain is elicited then this is a positive sign for Epicondylitis.
Another test is to resist extension of the middle finger-pain is a strong indicator for tennis elbow.
Rule out neural involvement
Advise on pain control-such as NSAID's like Ibuprofen.
Apply ultrasound or laser treatment to help reduce pain and inflammation as well as stimulate healing.
Use manual therapy treatments such as massage therapy, myofacial release and/or transverse friction techniques across the tendon
Try acupuncture which has been shown to be extremely effective for tennis elbow.
Advise on rehabilitation to return the athlete to full fitness.
Provide advice on neural stretching exercises if nerve tissue involvement is suspected
Give a steroid injection to reduce inflammation if present
Identify and correct any predisposing factors which lead to the onset of tennis elbow. Your tennis coach should also be able to provide some advice with regards your backhand technique.
Operate - if the conservative treatments have failed for about a year then this may be considered.
