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What is Tennis Elbow?

Tennis elbow is an injury to the muscles and tendons on the outside (lateral aspect) of the elbow that results from overuse or repetitive stress. The narrowing of the muscle bellies of the forearm as they merge into the tendons create highly focused stress where they insert into the bone of the elbow.

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Lateral Epicondylitis

Injury to the lateral aspect of the elbow is the most common upper extremity tennis injury. Tennis elbow is generally caused by overuse of the extensor tendons of the forearm, particularly the extensor carpi radialis brevis.

 

Commonly experienced by the amateur player, this injury is often a result of a one-handed backhand with poor technique the ball is hit with the front of the shoulder up and power generated from the forearm muscles, a late forehand swing preparation with resulting wrist snap to bring the racquet head perpendicular to the ball, or while serving, the ball is hit with full power and speed with wrist pronation (palm turned downward) and wrist snap which increases the stress on the already taught extensor tendons.

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The symptoms of tennis elbow (lateral epicondylitis) can persist for between 6 months and 2 years, although the condition usually resolves within 1 year with appropriate care. However, 4%–11% of patients require surgical intervention, and many patients with severe functional impairment or pain require other nonsurgical treatments. Presently, ESWT is only a secondary option for LE treatment and an alternative for patients who refuse surgical treatment.

The main impairments of LE are pain, decreased grip strength, and impaired upper-extremity strength. In the majority of studies, the VAS was used to evaluate pain at rest or during activity (0 indicating no pain and 10 the worst pain). Grip strength is a useful objective measure for evaluating disease severity, treatment response, and functional recovery.

 

Medial Epicondylitis

Medial epicondylitis is less common and characteristically occurs with wrist flexor activity and pronation. Medial epicondylitis can result from late forehand biomechanics where the player quickly snaps the wrist to bring the racquet head forward, the back-scratch or cocking phase when serving, which places tremendous stress on the medial tissues of the elbow, in the right elbow of a right-handed golf swing by throwing the club head down at the ball with the right arm rather than pulling the club through with the left arm and trunk (also referred to as “golfers elbow”), or improper pulling technique with certain swim strokes, especially the backstroke (also referred to as “swimmers elbow”).

It should be kept in mind that elbow epicondylitis is not limited to those persons playing tennis, golf, baseball or swimming and can result from any activity that puts the lateral or medial compartments of the elbow under similar repetitive stress and strain

 

 

Symptoms

       (e.g., hammering, turning a key, screw driver use, computer work, excessive hand shaking).

• Difficulty holding onto, pinching, or gripping objects

• Pain, stiffness, or insufficient elbow and hand movement

• Forearm muscle tightness

• Insufficient forearm functional strength

• Point tenderness at or near the insertion sites of the muscles of the lateral or medial elbow