Forewarned Is Forearmed
Written By Shirmilla Julka, Chartered Physiotherapist
Published – DAVID LLOYD Fitness
Elbow pain can be one of the most annoying conditions to have. Not only does it interfere with playing tennis, but it also affects daily activities involving repetitive movements such as twisting or gripping. Despite its name, it is not only tennis players that suffer. Anyone carrying out repetitive elbow or wrist movements can be prone to this condition – for instance dentists, keyboard operators, mechanics, gardeners, electricians, plumbers and carpenters to mention a few.
The medical term for tennis elbow is Lateral Epicondylitis. The outer bony part of the elbow is known as the lateral epicondyle. The forearm muscle that are involved in bending the wrist backwards and attached to the Lateral Epicondyle by various tendons collectively known as the Common Extensor Tendon.
Strenuous repetitive forearm movements cause minute tears in the Common Extensor Tendon. Eventually, the tendon becomes inflamed, causing pain and weakness in the tendon itself, as well as the forearm muscles. If the symptoms persist for a few months, adhesions and scarring can occur. One of the main nerves in the arm – the Ulnar Nerve – runs very closely to the Common Extensor Tendon and can become irritated by the inflammation causing further complications.
The reasons for the outset of tennis elbow vary enormously. In tennis players, one of the most common ways of inducing the condition is a sudden change in the size of the racquet grip. This puts a strain on the muscles and the Common Extensor Tendon in the forearm.
The severity of the pain differs from one individual to another. In the mildest form, the symptoms consist of dull ache around the outer bony part of the elbow. At its worst, the symptoms can be continuous sharp pain in both the elbow and forearm regions. The pain becomes worse when gripping and twisting movements of the wrist, especially those meeting resistance such as a backhand tennis stroke or pushing a heavy object will also make matters worse. The pain can travel down the forearm and sometimes up towards the shoulder. In certain cases, ‘pins and needles’ or numbness can occur in the arm and hand. This would indicate nerve involvement either in the wrist, elbow or neck.
Physiotherapy is the most successful treatment for tennis elbow but not the only one. It involves the use of gentle manipulation and electrotherapy – in the form of ultrasound sand interferential treatment – to settle the inflammation and restore normal function in the elbow. Strapping or splinting the painful area may be suggested in order to relieve the strain. If nerve symptoms are involved, then the condition becomes much more complicated and difficult to treat. In those cases, treatment in the neck region is required. Immediate treatment will usually produce successful results and an early rerun to sport.
Your GP may suggest a cortisone (steroid) injection. There is no risk of the side effects some people suffer when steroids are taken by the mouth since the drug is injected only into the affected area. After the injection, the pain may become more intense for one or two days before the condition is resolved. In persistent cases, a repeat injection may be required.
In rare cases, an orthopaedic consultant may have to carry out a tendon releasing operation. This is only performed as a last resort and only ever in extremely painful cases.