Tennis Elbow or Epicondylitis
Tennis Elbow or Epicondylitis is a condition of inflammation of muscles and tendons at the elbow joint. This painful and fairly common condition is usually caused by specific occupational and sports-related activities.
The elbow joint has two epicondyles (rounded projections at the end of the humerus bone), where the muscles, ligaments and tendons come together to hold the elbow joint in place. When the muscles groups at the epicondyle are injured due to stress or overuse, it leads to inflamed tendons, and possibly even tendon tears. Specifically, the extensor and flexor-pronator muscles and tendons are involved in the development of epicondylitis.
Types of Epicondylitis
There are two types of epicondylitis depending on which side the tendons are injured- on the outside (lateral) or inside (medial) of the elbow.
- Lateral epicondylitis (also called Tennis Elbow): inflammation of extensor forearm muscle and tendons, causing pain and tenderness on the outside of the elbow and upper forearm.
- Medial epicondylitis (also known as Golfer’s Elbow): inflammation of flexor forearm muscles and tendons, causing pain on the inside of the elbow.
What causes Epicondylitis or Tennis Elbow?
- This is mainly an overuse injury, caused by activities involving repetitive stress and repeated use of the forearm muscles.
- Tennis Elbow occurs in persons performing any activity that involves repeated use of the forearm extensors, which are used to extend the wrists and fingers. Both athletes (tennis and other racquet sports players), and non-athletes (cooks, auto workers, painters) are at risk of developing this condition. Tennis Elbow is about 5-7 times more common than Golfer’s Elbow.
- Golfer’s Elbow, occurs in persons who repetitively use their forearm for flexing and throwing actions- such as javelin or discus throwers, bowlers, or workers such as carpenters whose work involves such repetitive motions.
- It is more common in persons between 35 to 50 years of age.
- Direct injuries or trauma, such as in auto accidents, can also cause this condition.
What are the Main Symptoms?
- Pain and tenderness over the affected epicondyle
- Pain radiating into the forearm, which gets aggravated by activity
- A tender spot at or near the affected epicondyle on the inside or outside of the elbow.
- The onset of pain is usually gradual, and worsens with use of affected muscles
- If nerves are compressed by the inflamed and swollen tendons, then it leads to slight numbness, tingling sensations in fingers or even muscle weakness in the hand.
How is it Diagnosed?
- Tennis Elbow can be diagnosed using the Mills’ test. This test involves testing for pain while extending the wrist with the palm pronated, while moving the hand sideways towards the thumb.
- Golfer’s Elbow can be checked by the Golfer’s Elbow test which checks for pain, while pronating and flexing the wrist and forearm at the same time.
- If the diagnosis is uncertain, then elbow X-ray and MRI can be used for confirmation
How is it Treated?
Epicondylitis generally responds to conservative treatment. It is a self-limiting condition, which typically resolves within one year or sooner. The usual treatment options are:
- Rest and restriction of the offending activity
- Ice treatment on the elbow joint
- Use of a splint or brace to support the elbow and wrist
- Non-steroidal anti-inflammatory drugs (NSAIDs) for short-term pain relief.
- Steroid injections at the elbow joint. However, this can cause long-term damage to the joint, so should be used with caution.
- Platelet-Rich Plasma injection is found to be more beneficial than steroid injections
- Glyceryl trinitrate patches applied over the painful area can be helpful
- Physiotherapy focused on stretching, strength and flexibility improvement is an effective treatment choice, and is better than a wait-and-see approach.
- Surgery (only if there is no improvement after 3 to 6 months of conservative treatment): open and arthroscopic surgeries with dissection, release, and débridement of the deteriorated tendon
- Botulinum toxin injection at the elbow joint has been used to treat cases of severe tennis elbow, as an alternate to surgery.
Can it be Prevented?
As this is an overuse injury, patients can evaluate the particular actions that are excessively repetitive, and avoid or restrict them. Also, modifying or improving the playing techniques can help prevent sports-related cases that lead to Epicondylitis.