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Overview:

  • tennis elbow is caused by overuse
  • it will usually get better on its own without treatment
  • the best cure for tennis elbow is rest
  • recovery time can take 6 months to 1 year
  • there are non-surgical treatments for tennis elbow, both medical and holistic

In this article we’re going to take a deep dive into tennis elbow and discuss an overview of all the basics regarding the cause of a tennis elbow injury, the symptoms to be aware of to properly identify the injury, various treatment options, and provide a link to various braces that can assist in the recovery process

Tennis elbow is an injury caused by overuse. It typically comes as a result of repetitive motions and strenuous activities that cause a strain in the forearm. Tennis elbow can also develop following trauma, after knocking or banging the elbow into something hard that causes injury to the tendon.

Tennis elbow is a self-limiting condition which means it will eventually get better on it’s own without the need for treatment intervention. The healing process for tennis elbow can take anywhere from 6 months up to a year. The healing process can vary based on the severity of the injury. Because tendons heal very slowly, depending on the extent of injury to the tendons, the recovery time can take many months.

The injury site of tennis elbow is typically the lateral epicondyle, which is a bony bump on the outside of the elbow where the muscles attach to the bone. When symptoms of tennis elbow last for 6 weeks or less, they are categorized as sub-acute. However, when symptoms of tennis elbow persist for more than three months, it is considered to be chronic tennis elbow.

 

What is tennis elbow?

Tennis elbow is the term most commonly used for the medical syndrome, Lateral Epicondylitis. Tennis elbow is a painful condition and the most common overuse syndrome of the elbow, often related to excessive wrist extension.

More specifically, it is an inflammation of the tendons on the outside of the elbow, an injury involving the extensor muscles of the forearm. These tendons join the forearm muscles, and as these tendons and muscles are repeating the same repetitive movements, the overuse of these motions cause damage to the muscles and the tendons. The result is pain and discomfort on the outside of the elbow.

It is not surprising that a syndrome associated with overuse of the elbow, would often be associated with the sport of tennis and racquet sports and other sports activities involving frequent extension, flexing and general movement of the arm. However it is actually less commonly found in tennis players than non-tennis players.

Research shows that only 5% of people suffering from tennis elbow relate the injury to playing tennis. And of that 5% who do link tennis activity to their tennis elbow, those athletes are typically playing tennis a minimum of 3 days per week for at least 30 minutes per day.

Anyone who is regularly and consistently engaged in activity involving repetitive motions of the arm, is susceptible to a tennis elbow injury. However, most people who have experienced tennis elbow are between the ages of 30 and 50 years old. When it comes to sports like tennis or any racquet sport, the use of improper equipment or improper technique can instigate a tennis elbow injury. For instance, a frequently replicated improper tennis stroke, can cause injury to the lateral epicondylitis.

 

 

What is Lateral Epicondylitis?

Lateral Epicondylitis , more commonly called tennis elbow is when the extensor muscles of the forearm have experienced an injury. The extensor muscles originate on the lateral epicondylar region of the distal humerus. In a lot of cases, the insertion of the extensor carpi radialis brevis is involved.

The primary cause of epicondylitis is chronic stress of the tendon that attaches on the humerus. Chronic stress of the tendon happens as a result of contractile overuse. When the upper arm extremity is involved in repetitive activities and sport, overuse can occur. Activities that have been known to cause overuse include heavy use of the computer, heavy weight lifting, pronation and supination of the forearm with force, and reoccurring vibration. Despite the word tennis being used to describe this ailment, tennis elbow is commonly seen in sports like squash, badminton, baseball, swimming and sports involving field throwing. The repetition of winding back and forcefully releasing your arm, focused on one side of the body, is a movement also practiced regularly within specialized fields like electrical work, carpentry, gardening, and therefore tennis elbow can also be seen within these fields of practice.

 

Anatomy – Getting more familiar with the anatomy of our forearms

Our elbow joints are made up of 3 bones:

  1. Humerus (upper arm bone) – long bone that extends from the elbow to the shoulder. The humerus bone consists of 3 sections; a rounded head, narrow neck, and two short processes. It functions to connect the scapula to the two bones of the lower arm.
  2. Radius or radial bone – one of the two large bones in the forearm, stretches from lateral side (farther away from your body) of the elbow to the thumb side of the wrist and runs parallel to the ulna. It’s main purpose is to anchor the muscles of the upper arm and forearm.
  3. Ulna – one of the two large bones in the forearm, extends from the medial side (closer to your body) of the elbow to the smallest finger. It runs parallel to the radius and is the longer and larger of the two forearm bones.

The musculoskeletal system of the forearm is made up of both the bones as shown above, as well as the musculature or the system of muscles within the forearm. This system of muscles within the forearm all work together to perform a variety of movements. These movements, or motions produced by the forearm muscles are abduction, adduction, extension, and flexion. The forearm muscles are also responsible for two special movements, the supination (anterior rotation) and pronation (posterior rotation) of the forearm and hands.

Now that we’ve covered the basic musculoskeletal anatomy of the forearm, let’s talk about what parts of the muscular system and skeletal system of the forearm that play a role in a tennis elbow injury.

A joint within the body is a place where two bones connect to allow for parts of the body to move. The elbow joint, as the title would indicate, is the joint located at the midsection of the arm, that we refer to as our elbow. The elbow joint as seen in the photo above, is the meeting place for all 3 bones of the arm; the upper arm bone called the humerus, as well as the two forearm bones, referred to as the ulna and the radius. The elbow joint, is where all 3 of these bones come together to allow for all the motions of the arm. The joint is made up of cartilage and fibrous tissue.

At the bottom of the humerus, there are bony bumps called epicondyles. The bony bump located on the lateral side, or the outside of the elbow is called the lateral epicondyle.

There are also nerves that run through the arm. When a nerve is pinched, which is called nerve entrapment, you may feel tingling,pain, numbness, or weakness of the arm. The nerve in or near the elbow that most commonly gets pinched is called the ulnar nerve.

The ulnar nerve is also the nerve responsible for what people often refer to as ‘hitting your funny bone.’ The funny feeling that results from bumping your humerus. This action doesn’t do any damage to your elbow, arm or nerve, but can cause a funny (temporary) sensation which is the result of the ulnar nerve bumping against the humerus bone.

 

Diagnosis :

What does tennis elbow feel like? What are the symptoms of tennis elbow?

The first sign of a tennis elbow injury is pain or tenderness of the lateral epicondyle (elbow). The pain may move from the elbow and eventually spread throughout the forearm. In some cases the pain may extend as far as the back of the middle and ring finger. In addition to the pain and tenderness, the muscles within the forearm may feel tight and sore.

If you feel a confirmed diagnosis is needed and decide to schedule a doctors appointment to examine you for tennis elbow, your doctor will want you to flex your arm, write and elbow and identify which movements of your arm are causing pain. Identifying the types of motions, rotations that are most painful will help the doctor to identify which muscles, tendons are involved. In some cases your doctor may want to request imagining tests like and X-ray or MRI (magnetic resonance imaging)to confirm the diagnosis of tennis elbow but to also simultaneously rule out other more serious injuries.

***The feeling of numbness or tingling is usually indicative of a pinched nerve on or near the elbow. The nerve (most often the ulnar nerve) is typically entrapped and can cause pain, tingling, numbness, weakness of the hand, wrist and arm. Tennis elbow injury by itself would not cause tingling or numbness unless a nerve is also pinched in addition to the tennis elbow injury.

 

Treatment  : How to treat tennis elbow

Tennis elbow is a self-limiting condition which means it will eventually get better on it’s own without the need for treatment intervention. The healing process for tennis elbow can take anywhere from 6 months up to a year. The healing process can vary based on the severity of the injury. Because tendons heal very slowly, depending on the extent of injury to the tendons, the recovery time can take many months.

The injury site of tennis elbow is typically the lateral epicondyle, which is a bony bump on the outside of the elbow where the muscles attach to the bone. When symptoms of tennis elbow last for 6 weeks or less, they are categorized as sub-acute. However, when symptoms of tennis elbow persist for more than three months, it is considered to be chronic tennis elbow.

Medical management for the remedy of tennis elbow consists of NSAID, ice, elevation and the use of an elbow counter-force brace. If and only if the symptoms are resistant to these treatments, surgical treatment may be suggested. There are various forms of physical management and therapies that are used in the treatment of tennis elbow. The most commonly suggested methods of treatment are Cyriax therapy, stretching and exercises with the Flexbar.

How long does it take to recover from tennis elbow?

A number of simple treatments can help alleviate tennis elbow related pain.  It is also possible for tennis elbow to improve on its own in time with sufficient rest to allow for the injured tendons to recover. However, due to the slow rate at which tendons heal, tennis elbow recovery can take 6 months to 12 months to fully recuperate from.

How to Heal Tennis Elbow Quickly

If you are looking to speed up the recovery process, there are a variety of recommend ways to best cure tennis elbow at home, holistically as well as options for medical intervention.

How to treat tennis elbow at home

The best cure for tennis elbow without medical intervention is rest and relaxation, allowing the tendons enough time to recuperate naturally. You can accomplish this by modifying and/or eliminating activities that involve repetitive movement of the arm. Applying heat, ice and creams has also proven to be a helpful remedy for tennis elbow and allow for the natural recovery from the injury at home. Many people have found that wearing an elbow brace to support the elbow and the unavoidable motions of daily activity, to be a great tool in alleviating symptoms and assisting in the healing process.

In order to cure tennis elbow yourself, at home you first want to ensure you’ve reduced inflammation of the area and given the tendons and muscles a chance to sufficiently rest. Ice and compression can be utilized to assist in the reduction of the inflammation. Once inflammation subsides, you can begin gentle tennis elbow exercises to strengthen the affected muscles and avoid a recurrence of the same injury.

Below is a link to more detailed information on suggested lateral epicondylitis exercises (tennis elbow exercises). It is always best to consult a doctor following an injury to ensure you are ready for exercise. You can also visit a physical therapist to be assisted in pt exercise for tennis elbow. A single visit to learn and gain familiarity in pt for tennis elbow is often helpful in the learning process. After being shown the proper exercises, you can repeat them on your own and continue to recover from your tennis elbow injury at home. It is also possible to learn these options of exercise online if you do not wish to to see a physical therapist.

Click here to view detailed information on lateral epicondylitis exercises

A counter-force tennis elbow strap is often thought to be the best remedy for tennis elbow. The tennis elbow brace assists in reducing tension of the muscles as they interact with the lateral epicondyle to create motions of the arm.

Here are some recommended elbow braces to look into:

Best medicine for tennis elbow

  • Taking an anti-inflammatory medication can be useful on the onset of tennis elbow injury. Nonsteroidal anti-inflammatory (NSAIDs), such as ibuprofen, naproxen, or aspirin.
  • PT or physical therapy can also be effective to cure tennis elbow. PT that involves strengthening exercises as well as ultrasound therapy is often recommended as the best cure for tennis elbow
  • Direct injections of steroids or cortisol shots into the affected area have also proven to be a great way to heal tennis elbow
  • Steroid or cortisol injections straight into the effected area
  • There is also research in support of platelet-rich plasma (PRP) or autoglous blood injections (ABI), which is a process of collecting blood from a healthy area within the body and then injecting that healthy blood into the injured area of the lateral epicondyle
  • When all else fails, there is also the option of surgery available if the less invasive, formerly mentioned options do not prove to be helpful.

Tennis Elbow Surgery (Lateral Epicondylitis Debridement)

Prior to surgery, doctors will likely recommend an arthroscopy procedure. Arthroscopy is a procedure in which a surgeon can inspect, diagnose and repair problems inside a joint. The literal meaning of the word arthroscopy is defined as, ‘to look within the joint.’ During the arthroscopy the surgeon will insert a small camera into the elbow joint called an arthroscope.

Tennis elbow surgery, or lateral epicondylitis debridement is only recommended when the pain related to the injury is incapacitating and all other forms of treatment have been exhausted. Since standard recovery time for tennis elbow is 6 months up until 1 year, a doctor will not consider surgery as a reasonable treatment protocol for tennis elbow unless the pain and discomfort has persisted beyond a year, and shown no sign of improvement despite multiple attempts of non-surgical intervention. Only after all other tennis elbow remedies have failed, will a doctor consider the surgical treatment for tennis elbow. The surgery that is available, when necessary removes the damaged or diseased tendon tissue and then reattaches the healthy tissue to the bone. This surgery can be performed in an outpatient setting. Recovery time for tennis elbow surgery is estimated to be roughly 3 months to 6 months and may require continued strength exercises to properly heal.

Surgery may leave your arm temporarily immobile for a period of time and a splint will be provided. The splint is typically removed after about a week. Once the splint is removed exercise to stretch and restore flexibility begins, followed by light and gradually increasing exercises to rebuild strength. Strength building is usually started roughly 2 months after surgery. Patients are usually advised to return to athletic activity about 4 to 6 months after surgery.  Patients report successful outcomes after surgery 80% to 90% percent of the time, however some report a loss of strength after surgery. Total elbow surgery recovery time can take six months or more.

Only when the pain you’re experiencing is incapacitating and hasn’t responded to conservative treatments over the last six to 12 months, is surgery considered. It involves removal of the degenerated, diseased tendon tissues in an outpatient center. Because of the inconsistent results of surgery for lateral epicondylitis, every effort is made to find successful conservative treatment before surgery is considered.