Are you troubled by sharp pain in the elbow area, which seems to recur gradually even with the slightest exertion? The cause may be tennis elbow. It is fairly common to overload the muscles of the forearm, and it may affects also the physically inactive part of the population.
The illness got its name from a typical problem which affects especially recreational tennis players (elite tennis players rarely suffer from tennis elbow due to the technique), who incorrectly positioned their arm during the backhand shot. If we compare the anamnesis of the patients who have been diagnosed with lateral epicondylitis (tennis elbow), we will find out that more often than sport, the cause is connected to a long term repeated manual activity or continual overload on the muscles which extends the forearm and fingers (extensors) and muscles rotating the palm upwards (supinators).
WHAT DOES IT LEAD TO AND WHAT PROBLEMS OCCUR WITH IT
Tennis elbow is a type of tendinopathy (damage of the tissues) concerning the tendons. Degeneration with age, and primarily smaller injuries during the overload (usually repeated long term overload) are usually causes of the mentioned problems.
Specific activity (screwing, typing on computer, kneading the dough etc…) forms a inflammation changes in the transition between the bone and tendons, which are in case of tennis elbow located in the inner side of the forearm bone (lateral/radial/ epicondylus humeri).
ACUTE VS. CHRONIC FORM
Usually physically demanding jobs or one day jobs lead to functional disorder (what means there are no structural changes present, such as scars in the muscles or bone lump). Muscles which have been over-stressed are in a higher tension than its optimal (hypertonia).
Chronic form is developing in a longer time span, and it is labeled as such, when the problems last for longer than 6 weeks. In such case there can be structural changes in the muscles, tendons or the attachment on the bone. Based on the incorrect movement behavior, which is caused by substitute patterns so we would not feel the painful irritation in the area of the disorder, the problems can further occur in further locations as a transferred pain. The pain is caused by long stress on the forearm muscles, but also by toxic and metabolic waves (which form as a result of metabolic disorder), and general bacterial infection in the body etc…
SYMPTOMS AND MANIFESTATIONS
One of the first symptoms is usually pain while touching the inner side of the elbow. You feel uncomfortable sensation when you hold something, when you carry something (bag, child…), in advanced stage while lifting up a cup or other smaller activities. Typically the pain is going towards the wrist and hand, but also in shoulder and neck. The relieving position is when we slightly bend the elbow and wrist, when the muscles are not overloaded while stretching. The pain usually goes away when the muscles are in a relaxed condition. Redness of the skin may occur, as well as increased temperature and edema above the affected area.
Key element is a thorough anamnesis, from which it is possible to read why the mentioned problems occur. Stretching the 3rd finger is usually very sensitive, the induced strong pain in the area of the elbow joint is positive.
Clinical examination can be complemented by x-ray image in order to exclude the presence of the spurs or lumps. We can diagnose edema, degenerative changes or muscle ruptures by medical ultrasound.
It is important to not ignore the primary problems, because in this phase you can usually keep peaceful regime and use antiphlogistic creams (anti-inflammatory). For faster healing you can use the effect of focused shock wave therapy in the affected area, and for overloaded muscles you can use the radial shock wave therapy.
If you can’t stop working or exercising, you can use epicondylar tape, brace or kinesio tape for relieving the pain. But it should not be long term solution for your problems due to the formation of the wrong movement stereotypes, as has been stated already above. Arm sling is sometimes recommended or even gypsum cast.according to us this solution is not optimal, because it leads to muscles shortening, contractions and muscle atrophy.
Physiotherapy plays a critical role during these illnesses. In initial phase there is a focus on removing the pain, adjusting the muscle tension, relieving the blocked joints and other causes which are apparent from the kinesiological examination and cause you problems. Lastly, the patient should be educated about the regime of the treatment, so the problems would not recur.
- Tennis elbow
- Exercises relieving the elbow pain
- Exercise for strengthening and stabilization of the elbow
Author: FYZIOklinika physiotherapy Ltd., Prague, Czech Republic