What are the main symptoms of tennis elbow. How is tennis elbow diagnosed. What are the most effective treatments for tennis elbow. Can tennis elbow be prevented. Who is most at risk for developing tennis elbow. How long does it typically take for tennis elbow to heal.

Understanding Tennis Elbow: More Than Just a Sports Injury

Tennis elbow, medically known as lateral epicondylitis, is a condition that affects the tendons connecting the forearm muscles to the outer part of the elbow. Despite its name, this condition is not exclusive to tennis players. In fact, only about 5% of tennis elbow cases are actually caused by playing tennis. The majority of cases result from repetitive arm movements in various occupations and everyday activities.

Dr. Khorsandi, a hand surgeon at HSST, explains, “Tennis Elbow, or Lateral epicondylitis, is simply overuse of your extensor tendons.” This overuse leads to small tears in the tendons, causing pain and weakness in the affected arm.

Recognizing the Signs and Symptoms of Tennis Elbow

The primary symptom of tennis elbow is pain on the outside of the elbow, which can extend into the forearm and wrist. This pain may start as a mild discomfort and gradually intensify over weeks or months. Other common symptoms include:

• Weakness in the affected arm
• Difficulty gripping objects
• Pain when lifting or bending the arm
• Stiffness in the elbow
• Tenderness to touch on the outer part of the elbow

Is the pain always confined to the elbow area? Not necessarily. Some individuals may experience pain radiating down the forearm, particularly when performing activities that involve wrist extension or gripping.

Common Causes and Risk Factors for Tennis Elbow

Tennis elbow affects up to 3% of the population, primarily individuals between the ages of 30 and 50. While playing racquet sports can contribute to the condition, many other activities and occupations can lead to its development. Some common causes include:

• Painting
• Carpentry
• Playing certain musical instruments
• Repetitive kitchen work
• Plumbing
• Assembly line work
• Using a computer mouse for extended periods

Are certain professions more prone to tennis elbow? Yes, occupations that involve repetitive arm movements, particularly those requiring gripping or twisting motions, put individuals at higher risk. This includes carpenters, plumbers, painters, and even office workers who spend long hours typing or using a mouse.

Diagnosing Tennis Elbow: What to Expect

Diagnosing tennis elbow typically involves a combination of physical examination and medical history review. Your doctor will assess your symptoms and may perform specific tests to evaluate pain and weakness in your arm. These tests might include:

1. Applying pressure to the affected area
2. Asking you to extend your wrist against resistance
3. Checking for pain when you try to lift objects

In some cases, imaging tests may be necessary to rule out other conditions or assess the severity of the injury. These may include:

• X-rays to check for arthritis or bone spurs
• MRI scans to visualize soft tissue damage
• Electromyography (EMG) to evaluate nerve function

How accurate are these diagnostic methods? While physical examination and patient history are often sufficient for diagnosis, imaging tests can provide additional clarity in complex cases or when other conditions are suspected.

Effective Treatment Options for Tennis Elbow

The good news is that up to 95% of people with tennis elbow improve without surgery. Treatment typically begins with conservative approaches, including:

1. Rest and activity modification
2. Physical therapy exercises
3. Non-steroidal anti-inflammatory drugs (NSAIDs)
4. Bracing or splinting
5. Corticosteroid injections for pain relief

For more persistent cases, additional treatments may be considered:

• Ultrasound therapy to promote healing
• Extracorporeal shock wave therapy
• Platelet-rich plasma injections

In rare cases where conservative treatments fail to provide relief after 6-12 months, surgery may be recommended. Surgical options include removing damaged tissue or repairing the affected tendon.

How long does recovery typically take? The healing process varies depending on the severity of the condition and the chosen treatment approach. Most people experience significant improvement within a few weeks to months with proper care and adherence to treatment plans.

Preventing Tennis Elbow: Proactive Measures

While not all cases of tennis elbow can be prevented, several strategies can help reduce your risk:

• Proper warm-up before physical activities
• Using correct techniques in sports and work-related tasks
• Strengthening exercises for the forearm muscles
• Ergonomic adjustments in the workplace
• Taking regular breaks during repetitive activities
• Using appropriate equipment and tools

For athletes, particularly tennis players, additional preventive measures include:

1. Using a racquet with the correct grip size
2. Ensuring proper string tension
3. Learning and maintaining proper stroke techniques

Can lifestyle changes help prevent tennis elbow? Absolutely. Maintaining overall physical fitness, practicing good posture, and being mindful of repetitive movements in daily activities can significantly reduce the risk of developing tennis elbow.

Living with Tennis Elbow: Coping Strategies and Lifestyle Adjustments

For those dealing with tennis elbow, several strategies can help manage symptoms and improve quality of life:

• Applying ice or heat to the affected area
• Using ergonomic tools and equipment
• Practicing stress-reduction techniques
• Maintaining a healthy diet to support tissue healing
• Staying active with low-impact exercises

How can you modify daily activities to reduce strain on the affected arm? Consider these tips:

1. Use your other arm for tasks when possible
2. Lift objects with your palm facing up
3. Take frequent breaks during repetitive activities
4. Use a step stool to avoid overreaching

Is it necessary to completely avoid activities that may aggravate tennis elbow? While it’s important to avoid activities that cause pain, gradual reintroduction of movements under the guidance of a healthcare professional can be beneficial for recovery and preventing muscle weakness.

When to Seek Medical Attention for Tennis Elbow

While many cases of tennis elbow improve with self-care, certain situations warrant medical attention:

• Persistent pain lasting more than a few weeks
• Inability to carry out everyday tasks
• Significant weakness in the affected arm
• Pain that interferes with sleep
• Symptoms that worsen despite rest and home treatments

What should you expect during your first medical consultation for tennis elbow? Your healthcare provider will likely:

1. Review your medical history and symptoms
2. Perform a physical examination of your arm
3. Discuss your work and recreational activities
4. Recommend appropriate diagnostic tests if necessary
5. Develop a tailored treatment plan

Should you see a specialist for tennis elbow? In many cases, a primary care physician can effectively manage tennis elbow. However, if symptoms persist or are severe, you may be referred to an orthopedic specialist or a physical therapist for more specialized care.

The Future of Tennis Elbow Treatment: Emerging Therapies and Research

As medical science advances, new treatments for tennis elbow are being explored and developed. Some promising areas of research include:

• Stem cell therapy to promote tissue regeneration
• Advanced biological treatments using growth factors
• Innovative physical therapy techniques
• Minimally invasive surgical procedures

How might these new treatments change the landscape of tennis elbow management? While many of these therapies are still in the experimental stage, they hold the potential to offer faster recovery times, more targeted treatments, and possibly even prevent the condition in high-risk individuals.

Are there any ongoing clinical trials for tennis elbow treatments? Yes, numerous studies are currently underway to evaluate new treatment options. Patients interested in participating in clinical trials should consult with their healthcare providers or visit reputable clinical trial registries for more information.

As research progresses, our understanding of tennis elbow continues to evolve. This ongoing scientific inquiry not only promises more effective treatments but also offers hope for better prevention strategies in the future. By staying informed about these developments, individuals affected by tennis elbow can make more informed decisions about their care and potentially benefit from cutting-edge therapies as they become available.

Causes, Symptoms, and Risk Factors

Tennis elbow is painful weakening of the tendons that join your forearm muscles to your bones. It happens when you work your elbow too much by repeating certain motions. You might hear your doctor call it lateral epicondylitis.

Despite the name, tennis causes only about 5% of cases. You can get it after doing any kind of repetitive movement, like painting or using hand tools. Tennis elbow is a common injury that usually needs only minor treatment, but it takes time and rest to heal.

Where Does Tennis Elbow Cause Pain?

The pain is focused on the outside of your arm, where your forearm meets your elbow.

It’s related to a muscle and tendons in your forearm. Tendons connect your muscles to your bones. When you repeat certain arm movements, the tendons at the elbow end of a certain muscle — the extensor carpi radialis brevis (ECRB) muscle — may get small tears.

The tears may put stress on the rest of your arm, making it painful to lift and grip things. If you don’t get treatment, the pain can last a long time.

Tennis Elbow Symptoms

The most common symptom of tennis elbow is an ache on the outside of your elbow. Over time — from a few weeks to a few months — the ache turns into a constant pain. The outside of your elbow may be too painful to touch.

You can have tennis elbow in one or both arms.

Tennis Elbow Causes and Risk Factors

Tennis elbow affects up to 3% of people, mostly between the ages of 30 and 50.

Any activity that strains the muscles around your elbow over and over again can cause tennis elbow.

In tennis, hitting a backhand puts some stress on your forearm muscles, which clench when you hit the ball. If your technique is off or if you grip the racquet too tightly, it puts more stress on the tendons that connect your forearm muscles to your elbow. That can cause the tendons to get small tears.

You can get tennis elbow from playing other racquet sports, such as squash or racquetball. You can also get it from jobs or activities that involve repetitive arm motion, such as:

• Cutting down trees with a chain saw
• Painting
• Carpentry
• Playing some types of musical instruments
• Kitchen work, such as cutting with a knife
• Plumbing
• Working on cars
• Working on an assembly line

A direct blow to your elbow can also make the tendons swell.

Tennis Elbow Diagnosis

Your doctor will ask about your symptoms and medical history. They’ll check for pain in parts of your arm and ask you to do some simple motions such as straightening your wrist while they press on it.

You might have imaging tests like X-rays or MRIs to show what’s going on inside your arm. A test called electromyography (EMG) can use electrical currents to find nerve problems.

Tennis Elbow Treatment

Your doctor will first tell you to stop playing sports or doing certain kinds of work so your arm can rest. They’ll probably recommend physical therapy and medications such as aspirin, ibuprofen, or naproxen.

Your doctor might also give you:

• Corticosteroid medications. They’ll inject these into the area to help with swelling and pain.
• A splint or brace. You’ll wear this on your arm to help your muscles and tendons rest.
• Ultrasound. This treatment can break up scar tissue, increase blood flow, and promote healing.

Up to 95% of people who have tennis elbow get better without surgery. But you might need it if you still have pain after 6 to 12 months. Your doctor can remove damaged tissue through cuts in your arm.

Tennis Elbow Prevention

Some small changes might help lower your risk of tennis elbow.

• Keep your arms and wrists strong and flexible. Build strength with light weights. Warm up and stretch before any activity, especially one that involves making the same motions over and over.
• Try not to make repetitive movements.
• If you play a sport with a racquet, have an expert check your equipment to be sure it’s the right size and fit.

Signs, Symptoms and Treatment for Lateral Epicondylitis

Only about 5 percent of tennis elbow cases are actually caused by playing tennis. The majority of people who come down with tennis elbow, formally called lateral epicondylitis, get it as the result of everyday activities at work or home.

Because lateral epicondylitis has become popularly associated with tennis, many non-tennis players assume it can’t happen to them. Keep reading now to learn about this condition, its causes and symptoms, and how to know if you are at risk.

What Is Lateral Epicondylitis?

What is tennis elbow? Tennis elbow is the informal name of lateral epicondylitis, which pain specifically over the bony prominence where the muscle and fascia of the extensor tendons attach at the elbow.

“Tennis Elbow, or Lateral epicondylitis, is simply overuse of your extensor tendons,” says Dr. Khorsandi, hand surgeon at HSST.

Your elbow joins your humerus or upper arm bone to your radius and ulna, the bones in your forearm. The elbow joint itself is made of muscles, ligaments, and tendons.

The main tendon in your elbow that is usually responsible for tennis elbow pain is called the Extensor Carpi Radialis Brevis (ECRB). This tendon attaches to your bones at protrusion called the lateral epicondyle, which is where the name lateral epicondylitis comes from.

Tennis elbow occurs when the ECRB is overworked. The tendon may be torn or just strained. In either case, it weakens, becoming inflamed and painful.  Dr. Khorsandi, also says that sometimes the fascia, or the outer layer that envelopes the muscle in this region can become simply too tight or restrictive on the muscle contained within it.  Thus the muscle wants to expand, but it is limited due to the tight tissue and fascia, resulting in pain.

What Causes It?

Tennis elbow is a repetitive motion injury. It is caused by repeatedly moving your hands, arms, and elbows in the same motion over and over. This movement rubs the tendon against the bony protrusions in your bones at your elbows, causing micro-tears, inflammation, and the pain that characterizes the condition.

It’s Not Just Tennis

Tennis elbow got its common name because the injury frequently happens to tennis players. It is particularly common in players who weren’t taught or don’t use proper technique on their backhand strokes.

The vast majority of suffers are not tennis players, however. Other hobbies that are known to cause tendonitis elbow include:

Many elbow tendonitis sufferers acquire the condition as the result of their work. Professions at high risk include:

• Plumbers
• Construction workers
• Carpenters
• Butchers
• Cooks
• IT Professionals
• Autoworkers

Anyone who engages in repetitive hand, wrist, or arm movement at work or during pleasure activities may be at risk.

Age

Tennis elbow can happen at any age. It is most common between adults 30 to 50 years old, however.

Insidious Cases

Occasionally, adults can come down with tennis elbow without engaging in any observable repetitive motion activities. These cases are referred to as “insidious cases.”

Impacts of Tennis Elbow on Quality of Life

The weakness that results from tennis elbow can make it difficult for suffers to grasp or lift objects. This can seriously complicate the activities of daily living. Individuals can struggle to:

• Eat and drink
• Bathe and dress themselves
• Open and close doors
• Drive
• Write or operate a keyboard
• Pick up or carry objects

Simply moving through one’s day can be challenging. Engaging in one’s favorite hobbies or caring for another person can be difficult or impossible.

Tennis elbow can have also seriously impact sufferers’ ability to work. The personal challenges to personal care and mobility limit their ability to get to work in the first place. Once they are at work, they are often unable to use the tools required to do their jobs.

Extreme, constant pain can make thinking, focusing, and completing tasks difficult. Jobs that require the use of the injured arm can be impossible. Ultimately, if tennis elbow is left untreated or if it does not respond to treatment, it can drive people out of the workplace entirely.

In extreme cases, it can lead to disability and a permanent loss of wages. Nationally, the condition accounts for significant loss of productivity in the workplace and substantial health care expenses. It is a burden that both workers and employers share.

Tennis Elbow Signs and Symptoms

The primary symptoms of tennis elbow are pain and weakness.

Tennis elbow pain is very specific. It is focused on the outside of your elbow, near the bottom of the joint. In some cases, the pain extends down to include your forearm and your wrist.

The pain can come on without warning and may be extreme. It may get worse when you attempt to grip or squeeze something with your hand. The pain may also flare up particularly badly when you use your hand or arm in the repetitive motion that caused the injury.

The weakness associated with tennis elbow affects elbows, wrists, and hands. You may find that you have trouble holding onto glasses or mugs, manipulating doorknobs, or picking up objects like pencils or keys.

Onset

Lateral epicondylitis may set in all at once with no clear inciting incident. Alternatively, it can start out as mild or occasional pain but gradually get worse over a long period of time.

Left untreated, the pain associated with tennis elbow can become a constant, intense agony.

It is possible to have tennis elbow just one arm or in both arms at the same time. About two-thirds of sufferers get it in their dominant arms. Women are slightly more likely to suffer from tennis elbow than men.

What You Won’t See

Tennis elbow symptoms are not externally visible. Sufferers do not experience bruising, redness, visible swelling, rashes, or other outward signs of their injuries.

Diagnosis

If you suspect that you have lateral epicondylitis, you should consult with your doctor. It is impossible to accurately diagnose tennis elbow yourself, as there are other numerous other conditions with similar symptoms that it might be confused for.

There is no direct test that your doctor can use to determine if you are suffering from tennis elbow. Instead, he or she will use a combination of assessments to verify that you are suffering from the condition.

First, your doctor will review your symptoms and your personal medical history. They will ask your work and home activities, looking for actions or situations that might cause a repetitive strain injury. It is important to tell your doctor about all of your activities and injuries during this stage so that they can make an accurate diagnosis.

Your doctor may then palpate or carefully move your arm. They will ask you about your pain levels as it moves, and look for patterns and correlations.

In some cases, your doctor may use medical imaging techniques to further explore your condition and rule out other possible causes. For example, they may take X-rays to look for arthritis or an EMG to check for nerve damage. They may use an MRI to make sure the pain is not related to a herniated disk which can cause similar symptoms.

Together, these approaches will allow your doctor to determine if you have tennis elbow and, if so, how severe it is.

First-Line Treatments

In its mildest forms, lateral epicondylitis is often treatable to simple therapies and over-the-counter medications. Your doctor may recommend rest and pain relievers such as aspirin or ibuprofen for the pain.

Ergonomic modifications

“Sometimes just changing your work space at work or form at play can make a huge difference in treating tennis elbow,” commented Houston hand surgeon Dr. Khorsandi.  He states that you can change the type of keyboard, mouse, desk height, and much more.  In sports, your form could impact how much stress / pain you have localized to the lateral epicondyle.  Many corporate offices have consultants to help with ergonomic modifications.

Change How You Move

Your doctor may recommend that you take a break from repetitive motion activities, if possible. This may require exploring new hobbies or seeing if you can get temporarily reassigned at work to give your body a chance to rest and heal.

Stretching Exercises

Simple wrist and forearm stretches can help. Your doctor may teach you some of these stretches and assign you a frequency with which to do them. They may also teach you simple self-massage techniques to help with the pain.

Braces

Your doctor may recommend using a brace to support your arm and limit the strain on your abused tendon. Compression sleeves may also help.

Heat or Ice

Applying heat or ice per your doctor’s instructions can speed up the healing process. You may also be instructed to elevate your arm while heating or icing it.

Dietary Changes

In some cases, removing inflammatory foods like sugar, grains, dairy, and red meat from your diet can help speed up your healing. Your doctor may also prescribe supplements that enhance your body’s ability to heal itself quickly.

Other Options

Some doctors may suggest pursuing acupuncture, extracorporeal shock wave therapy, and other alternative healing modalities. These options are less widely accepted but are not entirely uncommon.

More Advanced Treatments

If your tennis elbow pain does not respond to first-line interventions in six months to a year, more intensive treatment may be needed. Examples include:

• Periodic corticosteroid injections to reduce swelling ease pain
• Ultrasound treatment to promote blood flow and healing
• Physical therapy

Between 80 and 95 percent of cases respond to these treatments and do not require surgery. If your pain and weakness do not change, however, surgery may become necessary. There are two forms of lateral epicondylitis surgery.

Both forms involve cutting away damaged muscle or tendon and attaching what remains to the bone in place of the removed section. Both types of surgery are outpatient procedures that do not involve overnight hospital stays except in rare conditions.

Open Surgery

Open surgery is the most commonly selected option for surgical treatment. Your doctor will make a small cut over your elbow to do the work needed. The procedure is usually considered outpatient surgery, with no need to be hospitalized overnight.  The recovery is usually fast, and pain relief is noticible very quickly.

Arthroscopic Surgery

In arthroscopic surgery, your surgeon will make a tiny incision. They will then work inside your body using specialized, miniaturized instruments.

Surgical Risks and Rehabilitation

All surgeries involve risk, and your doctor will review these risks with you in advance to ensure you are a good candidate for the procedure. They will also help you choose the right kind of surgery for you.

Post-surgery you will have sutures and a splint for approximately one week. After that, you can expect approximately two months of very light physical therapy to help you recover. Between two and six months post-surgery, you may work up to more intensive therapy exercises as you regain full strength.

Prevention

Maybe you are at high risk of developing tennis elbow or are already experiencing mild symptoms. If so, there are many things you can do to lower or risk or slow the progression of your condition.

Check Your Tools

Whether you play a sport or engage in repetitive motion at work, investing in the right tools can help. If you are an athlete or sportsman, have a professional assess your gear and techniques. Repair or replace gear that is not appropriately sized or specced to your needs and correct any techniques that you may be performing incorrectly.

In the workplace, explore opportunities for more ergonomic tools such as keyboards and mice, or look for ways to alter your working environment to reduce the strain on your hands, arms, and elbows.

If you are a hobbyist, invest in braces, compression sleeves, and other support tools.

Build Strength

Work with your doctor or therapist to identify and regularly practice exercises that can strengthen your hands, wrists, and arms. Ask them to show you new ways of moving that enable you to spread the strain across your shoulders and biceps to reduce the strain on your elbow and lower arms.

Rotate

If possible, rotate between hobbies and stations at work. This variety will reduce the strain on your elbow and give it breaks to rest and heal after a period of strain.

Getting Help 

If you suspect that you may have lateral epicondylitis, don’t wait. Contact the tennis elbow experts for assessment and start getting the treatment you need today.

Tennis Elbow | Cedars-Sinai

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What is tennis elbow?

Tennis elbow (lateral
epicondylitis) is swelling of the tendons that bend your wrist backward away from your
palm.

A tendon is a tough cord of tissue
that connects muscles to bones. The tendon most likely involved in tennis elbow is
called the exterior carpi radialis brevis.
Tennis elbow is usually diagnosed in both men and women between ages 30 to 50.

What causes tennis elbow?

Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. Your forearm muscles, which attach to the outside of your elbow, may become sore from excessive strain. When making a backhand stroke in tennis, the tendons that roll over the end of our elbow can become damaged. Tennis elbow may be caused by:

• Improper backhand stroke
• Weak shoulder and wrist muscles
• Using a tennis racket that is too tightly strung or too short
• Other racquet sports, like racquetball or squash
• Hitting the ball off center on the racket, or hitting heavy, wet balls

However, many people who suffer from tennis elbow do not play tennis. The problem can be caused by any repetitive movement. Other causes of tennis elbow include:

• Painting with a brush or roller
• Working a chain saw
• Frequent use of other hand tools on a regular basis
• Using repeated hand motions in various
  types of work, such as butchers, musicians, dentists, and carpenters

What are the symptoms of tennis elbow?

The following are the most common symptoms of tennis elbow. However, you may experience symptoms differently.

At first, you may have pain, burning, or an ache along the outside of your forearm and elbow. With time, the pain gets worse. If you continue the activity that caused your condition, the pain may spread down to your wrist, even at rest. Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance. You may also feel pain when you try to lift and grip small objects, such as a coffee cup. A weak grip is another symptom of tennis elbow.

The symptoms of tennis elbow may
look like other medical problems or conditions. Always see your healthcare provider for
a diagnosis.

How is tennis elbow diagnosed?

Your healthcare provider can
usually diagnosis your tennis elbow with a physical exam. In some cases, you may have
certain tests, such as:

• An X-ray to look at the bones of your elbow to see if you have arthritis in your elbow.
• MRI can show your tendons and the
  amount of damage. An MRI of your neck can show if arthritis is in your neck, or disk
  problems in your spine are causing your arm pain.
• Electromyography (EMG) of your elbow
  may show if you have any nerve problems that may be causing your pain.

How is tennis elbow treated?

It’s important to avoid the movement that caused your injury in the first place. Treatment may include:

• Rest and stopping the activity that produces the symptoms
• Ice packs to reduce inflammation
• Strengthening and stretching exercises
• Anti-inflammatory medicines such as
  ibuprofen or naproxen

If these treatments don’t work,
your healthcare provider may talk to you about:

• Bracing the area to keep it still for a few weeks or use of a special brace with activities
• Steroid injections to help reduce swelling and pain
• A special type of ultrasound that can help break up scar tissue, increase blood flow, and promote healing
• Surgery is rarely necessary

What can I do to prevent tennis elbow?

• Keep your arms flexible and
  strong.
• Stay away from repetitive
  movements.
• Warm up before exercising or using
  your arms for sports or other repetitive movements.
• If you play a racquet sport, make sure
  your equipment is right for you.

When should I call my healthcare provider?

Call your healthcare provider if you have any of the following:

• Pain or trouble moving affects your
  daily activities
• Pain doesn’t get better or it gets
  worse with treatment
• You see a bulge or lump on your
  arm

Key points about tennis elbow

• Tennis elbow is swelling or tearing of
  the tendons that bend your wrist backward away from your palm.
• It’s caused by repetitive motion of
  the forearm muscles, which attach to the outside of your elbow. The muscles and
  tendons become sore from too much strain.
• Symptoms include pain, burning, or an
  ache along the outside of the forearm and elbow. It gets worse and may spread down to
  the wrist if the person continues the activity that causes the condition. The grip
  may become weak.
• Tennis elbow can be treated with rest
  and medicines to help with the inflammation. Exercises often help too. Rarely,
  surgery may be done to repair the tendon.
• You can help prevent tennis elbow by
  doing things like warming up before exercise or sports, increasing activity slowly,
  using the right equipment for activities, and strengthening your arm muscles.

Next steps

Tips to help you get the most from a visit to your health care
provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember
  what your provider tells you.
• At the visit, write down the name of a new diagnosis, and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed, and how it
  will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results
  could mean.
• Know what to expect if you do not take the medicine or have the
  test or procedure.
• If you have a follow-up appointment, write down the date, time,
  and purpose for that visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Thomas N Joseph MD

Medical Reviewer: Kenny Turley PA-C

Medical Reviewer: L Renee Watson MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Tennis Elbow vs. Golfer’s Elbow – What’s the Difference?

-Causes of Tennis Elbow

-Treatment of Tennis Elbow  
-Tennis Elbow vs Golfers 

If you’re experiencing regular pain when engaging in activities involving your forearm muscles, tennis elbow may be to blame. However, many patients confuse tennis elbow and golfer’s elbow. Here we will discuss different aspects of tennis elbow that will help you figure out if you may have this painful disorder. We’ll also highlight some of the differences between tennis and golfer’s elbow.

Tennis elbow can be quite uncomfortable, but the vast majority of patients will regain full strength and range of motion with proper treatment.

What Is Tennis Elbow?

Tennis elbow, also known as lateral epicondylitis, is a common overuse injury resulting from repetitive motion involving the tendons in your elbow. These tendons, the extensor carpi radialis brevis and extensor digitorum communis of the forearm, extend and stabilize the wrist as they anchor your muscles to your bones. When the attachment site weakens, you start to experience pain and tenderness while engaged in everyday activities involving gripping, grasping or lifting.

The first documented reference to tennis elbow was published in 1883, noting that frequent tennis players presented with pain in and around the elbow area of their racquet arm. Subsequent studies observed that using inappropriately matched equipment for one’s body size and muscle strength, gripping the racket too hard, hitting the ball off center and using poor technique on ground strokes increased the likelihood of tennis elbow pain.

What Are the Signs of Tennis Elbow?

Tennis elbow usually develops gradually, starting off as mild discomfort and worsening as time passes. In most cases, there is no specific incident that can be linked to the start of the symptoms.

Many people suffering from tennis elbow experience recurring pain radiating from the elbow all the way down the forearm, with pain that increases when they attempt to extend or straighten the elbow. Other common signs of tennis elbow include:

• Difficulty grasping or lifting objects
• Weak grip strength
• Sharp twinges when engaged in activities using the elbow
• Pain during and after activities involving the wrist
• Numbness or tingling in the fingers
• A dull ache when resting

Tennis elbow most often affects your dominant arm, meaning that right-handed people are more likely to develop tennis elbow in their right elbow and left-handed people are more likely to develop tennis elbow in their left elbow. However, it is possible for people to develop the condition in both arms. It is estimated that up to 20 percent of patients have some degree of bilateral tennis elbow.

Tennis elbow is usually considered degenerative rather than acute. If left untreated, tennis elbow can progress to the point where you have difficulty with simple everyday activities such as turning a doorknob, shaking hands, brushing your teeth or holding a coffee cup.

What Causes Tennis Elbow Pain?

Tennis elbow is most common in people ages 30 to 50, although the condition can be seen in people of all ages. Depending upon their activity level, children and senior citizens can be diagnosed with tennis elbow as well. There is no gender-related component to tennis elbow, and men and women are equally likely to be diagnosed with the condition.

Overuse is the most common cause of tennis elbow pain. When you frequently engage in activities that place stress on the tendon attachments and the muscle-tendon unit, microscopic tears form in the tendon where it is attached to the bone. These tears lead to the inflammation and pain associated with tennis elbow. Typically, overuse is defined as a high activity level three or more times per week with activity lasting 30 minutes or more per session. A poor overall fitness level can exacerbate the problems caused by overuse of the forearm and elbow area.

Tennis elbow pain can sometimes be linked to specific injuries or traumas. If you suffer a direct blow to the elbow, this could result in the swelling of the tendon and subsequent degeneration. When seeking treatment for your condition, it is important to inform your doctor of any injury or trauma that could be linked to the development of tennis elbow.

Finally, as with many medical conditions, genetics play a role in the development of tennis elbow. Some people are born with tendons that are naturally less durable, which makes them prone to developing the condition at an earlier age or in conjunction with pain in the shoulders and feet.

How Do You Get Tennis Elbow Without Playing Tennis?

The Nirschl Orthopaedic Center reports that half of all tennis players will be diagnosed with tennis elbow at some point in their lives. However, people who play tennis make up less than 5 percent of all reported cases of the condition. This means the majority of people diagnosed with tennis elbow can attribute their condition to other causes.

Can you get tennis elbow from baseball and other sports, then? The answer is yes. Baseball pitchers are commonly affected by tennis elbow, especially if they haven’t been properly trained as to the correct pitching mechanics, frequently pitch curve balls or have a training schedule that is too vigorous. Younger players with elbows that are still developing are particularly prone to tennis elbow.

Other sports that have been linked to tennis elbow include football, javelin, discus, badminton and squash. The more frequently a person plays one of these sports, the more likely they are to develop the condition.

If you don’t play sports at all, you can still get tennis elbow from any sort of regular manual labor that involves lifting of the wrist and/or repetitive turning motions. This includes plumbing, meat cutting, painting and bricklaying, as well as typing. Hairdressers are also vulnerable to tennis elbow due to their frequent use of scissors, shears and other styling tools.

If you enjoy arts and crafts in your spare time, you may be vulnerable to tennis elbow due to the fine, repetitive hand and wrist movements involved in completing projects. For example, knitters and crocheters who work on projects for several hours at a time are prone to developing elbow pain. Scrapbooking can also be problematic due to the detailed cutting that is often involved.

How Is Tennis Elbow Diagnosed?

If you suspect that you may be suffering from tennis elbow, medical treatment is needed. Self-diagnosis can be dangerous, as tennis elbow is easily mistaken for other conditions. According to the American College of Sports Medicine, there are at least 43 different documented pathologies of the elbow joint. Many of these conditions, such as bursitis and arthritis, have symptoms that are similar to those of tennis elbow.

Tennis elbow is diagnosed based on a description of how your symptoms developed and what type of activities you engage in during a particular day. Your doctor will also consider factors such as whether you’ve previously injured your elbow and whether you have a history of nerve disease or rheumatoid arthritis.

During the initial examination, your doctor may ask you to perform basic tasks such as extending your arm fully straight and trying to straighten your wrists and fingers against resistance. If these tests are inconclusive, your doctor may order X-rays, an MRI scan or an EMG before making a final diagnosis. Bone scans may be done in rare cases to look for stress fractures or disease conditions that could be causing the elbow pain.

To assist your physician in obtaining an accurate diagnosis, it’s helpful to bring the following to your initial appointment:

• A written list of your symptoms
• Any questions you might have
• A list of any medications you are taking, including both prescription drugs and over-the-counter medicines
• A list of any previous surgeries you’ve had, as well as any injuries or other medical conditions that may be relevant to the pain you are experiencing

How Is Tennis Elbow Treated?

Ice and anti-inflammatory, over-the-counter pain relievers such as aspirin or ibuprofen can provide temporary relief for your elbow pain. You will also want to rest the affected area as much as possible by stopping activities that irritate the tendon or by changing your technique to reduce stress on the forearm muscles.

Unfortunately, basic self-care at home will not resolve your tennis elbow pain permanently. The body requires new blood vessels and collagen proteins to heal the affected tendon.

Treatments for tennis elbow depend upon the severity of your pain, but may include:

• Cortisone Injections: Cortisone is used to control inflammation and relieve tennis elbow symptoms. They cannot be used long term, however. Too much cortisone can weaken sensitive tissues over time. Injections are given around the tendons and over the most painful point of the elbow, but are not directly injected into the tendon tissue itself.
• Bracing: When tennis elbow is linked to your occupation, it can be difficult to avoid activities that cause pain. In this case, functional bracing can be used to disperse forces that would normally be absorbed at the point of injury. Braces apply pressure on the muscles below the elbow to allow you to complete your daily activates with less discomfort. Tennis elbow braces are also called counterforce braces, and most commonly come in full elbow sleeve or simple strap styles that can be adjusted to provide the necessary tension around the forearm area. The braces can be worn throughout the day but should be removed before going to sleep at night.
• Physical Therapy: An experienced physical therapist can develop a personalized exercise program designed to strengthen the forearm, wrist and shoulder muscles while bringing in a new blood supply. The therapist may use massage, ultrasound and other muscle-stimulating techniques to promote healing. You might also be referred to an ergonomic specialist and/or occupational therapist if your condition is related to work activities.
• Surgery: According to the American Academy of Orthopaedic Surgeons, 80 to 85 percent of tennis elbow cases will improve after six months to one year of nonsurgical treatment. However, some patients may require surgery to remove the pain-producing tendon. After surgery, the arm is temporarily immobilized using a splint. The patient begins gradual strengthening exercises three to four weeks after the procedure, with the goal of being able to return to light athletic activity within four to six weeks and competitive athletic activity within four to six months.

Preventing Tennis Elbow Pain

Although tennis elbow treatment is very effective at relieving pain and improving range of motion, it’s possible for the condition to reoccur if the patient slips back into old habits. Modifying your daily routine is a key component of staying injury free.

If your tennis elbow is caused by work-related duties, it’s recommended that you speak to your supervisor or a company human resources representative about making accommodations to avoid a relapse. For example, if typing is the primary cause of your injury, you may need to type on a split keyboard to help your hands stay in a more natural line and use a wrist pad to keep your hands level with the keyboard at all times. You might also need to take more frequent breaks to allow for stretching and a change of positions.

If your pain is related to tennis or another sport, individualized coaching can help you refine your technique to prevent injury. In addition, a coach can check that your equipment properly fits your needs. For example, switching to a looser-strung tennis racquet reduces the stress on your forearm and keeps you from overworking your injured muscles and tendons.

Regardless of whether your tennis elbow is linked to work or recreational activities, you should make it a priority to follow through with the approved course of physical therapy. Strengthening your arm, shoulder and upper back muscles will help prevent future problems by taking stress off your elbow. Regular use of the exercises recommended by your therapist will allow you to maintain an active lifestyle without worrying about aggravating your injury.

TENNIS ELBOW VS. GOLFER’S ELBOW

You may have heard of both tennis elbow and golfer’s elbow before, but you probably don’t know what sets them apart. There’s a reason many patients confuse tennis elbow and golfer’s elbow. They share quite a few characteristics:

• Both are overuse injuries, caused by repetitive motions involving your arm and wrist.
• They both are characterized by damage to the tendons that attach your forearm muscles to the bone at your elbow.
• They both cause inflammation of the tendons but can progress to partial or full thickness tears of the tendon.
• Both cause pain to the elbow region.
• You don’t need to participate in the sport for which they’re named to get these conditions.
• Both start gradually but can get worse over time.
• Treatment for both is similar, beginning with giving your elbow and wrist a rest to reduce the amount of strain.

Despite these similarities, they are not the same conditions. In fact, they are quite distinct. Determining the correct cause for your elbow pain is the best method for receiving proper treatment. That’s why it’s important to visit your doctor who can assess your elbow and give you an accurate diagnosis.

WHAT IS GOLFER’S ELBOW?

Golfer’s elbow is a completely different disorder than tennis elbow. Medial epicondylitis, more commonly referred to as golfer’s elbow, is discomfort or irritation occurring on the inner side of the arm and elbow that is caused by activities that require repeated flexing or twisting of the wrist — for example, anything that requires you to bend your wrist downward or overuse your forearm muscles. When you do activities that require repeated lifting, especially if your elbow is extended and your palm is facing down, this can also cause the condition. 

Despite the name, golfer’s elbow isn’t just limited to people who play golf. Repetitive tasks like gardening, shoveling, throwing a ball, painting and similar activities all put you at risk for golfer’s elbow. It can also be seen in weight trainers with poor technique, as well as those who work in an assembly line repeatedly bending and straightening the elbow. It is most common in people over age 40, smokers, those who are obese and those who perform repetitive activities for two or more hours per day.

People who are suffering from golfer’s elbow often experience pain when making a fist or twisting the forearm. In many cases, the affected area is tender to the touch or slightly swollen. If you are suffering from golfer’s elbow, pain often seems to worsen when you attempt to flex your wrist, pick up something with your palm down or squeeze a ball.

If the condition is not treated promptly, golfer’s elbow can cause weakness in the hands or wrist as well as stiffness in the elbow. The treatments for golfer’s elbow and tennis elbow are similar in most cases, but you will need to seek medical care to learn the best way to handle your condition.

DIFFERENCES BETWEEN GOLFER’S AND TENNIS ELBOW

There is widespread confusion about how golfer’s and tennis elbow differ. And although they’re often confused, there are a few distinct characteristics of each condition that will help you tell them apart:

• Inflammation Location: The difference between golfer’s and tennis elbow centers on where the elbow is inflamed. A person suffering from tennis elbow will experience inflammation of the outside of the elbow and forearm areas, while a person suffering from golfer’s elbow will experience inflammation on the inner side of the arm and elbow.
• Tendon Affected: Tennis elbow affects the lateral (outside) epicondyle tendon. These are connected to the muscles that stretch your wrist backward and allow you to spread your fingers. Golfer’s elbow affects the medial (inside) epicondyle tendon. This is attached to the muscles you use to flex your wrist and contract your fingers, like when you grip something.
• Symptoms: The side effects of these conditions can be very similar, but they are on opposite sides of the elbow and arm. Tennis elbow presents with pain and tenderness experienced on the outside of your elbow, while golfer’s elbow can be felt on the inside of your elbow and down your arm. Golfer’s elbow can also cause numbness or tingling in your fingers.

GET HELP FOR YOUR TENNIS ELBOW PAIN

The goal of tennis elbow treatment is to help the patient regain total arm strength and endurance. Seeking medical care as soon as possible is the best way to get back to your daily routine. The medical experts at OIP will be able to diagnose your condition accurately, so you know definitively whether you have tennis elbow or golfer’s elbow.

Schedule an orthopedic appointment at OIP by using our online form or by calling 717-761-5530.

Last Updated on 06/12/2020

Tennis Elbow – Lateral Epicondylitis

With tennis elbow, some patients will find that their symptoms go away spontaneously within a year. For others, both surgical and non-surgical treatments are available. Non-surgical treatments will almost always be considered first.

These can include:

• Activity modification: Initially, the activity causing the condition should be limited. Modifying grips or techniques, such as use of a different size racket in tennis, may relieve the problem.
• Medication: Anti-inflammatory medications may help alleviate the pain.
• Brace: A tennis elbow brace, a band worn over the muscle of the forearm just below the elbow, can reduce the tension on the tendon and allow it to heal.
• Physical therapy: Stretching and/or strengthening exercises, ultrasound, or heat treatments may help the pain.
• Steroid injections: A steroid is a strong anti-inflammatory medication that can be injected into the area.
• Autologous blood injections (ABI) or platelet rich plasma (PRP): This includes withdrawing blood from an uninjured site and reinjecting it into the area of the lateral epicondyle. This therapy is a major focus of new research and offers some promise.

Surgery is only considered when the pain is incapacitating and has not responded to other treatments, and when symptoms have lasted six to 12 months. Surgery involves removing the diseased, degenerated tendon tissue. The surgery would be performed in an outpatient setting.

Recovery

Recovery from surgery will include physical therapy to regain motion of the arm. A strengthening program will be necessary to return to prior activities. Recovery can be expected to take several months.

Talk to your hand surgeon to determine the best treatment option for you.

© 2017 American Society for Surgery of the Hand

This content is written, edited and updated by hand surgeon members of the American Society for Surgery of the Hand.Find a hand surgeon near you.

Physical Therapy Guide to Tennis Elbow (Lateral Epicondylitis)

ChoosePT Guide

Most people who get tennis elbow don’t play tennis! In fact, less than 5% of all tennis elbow cases occur in people who play tennis. Tennis elbow can happen to anyone who repeatedly uses their elbow, wrist, and hand for their job, sport, or hobby.

Physical therapists are movement experts who improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To locate a physical therapist in your area, visit Find a PT.

Find a PT Near You!

What Is Tennis Elbow (Lateral Epicondylitis)?

Tennis elbow is a painful condition caused by overuse of the “extensor” muscles in your arm and forearm, particularly where the tendons attach to rounded projections of bone (epicondyles) on the outside or lateral aspect of the elbow. The muscles you use to grip, twist, and carry objects with your hand all attach to the “lateral epicondyle” at the elbow. That’s why a movement of the wrist or hand can actually cause pain in the elbow.

Prolonged use of the wrist and hand, such as when using a computer or operating machinery —and, of course, playing tennis with an improper grip or technique—can lead to tennis elbow. It can happen to athletes, non-athletes, children, and adults. It occurs more often in men than women, and most commonly affects people between the ages of 30 and 50.

Signs and Symptoms

Symptoms of tennis elbow can occur suddenly as a result of excessive use of the wrist and hand for activities that require force, such as lifting, twisting, or pulling. Forceful activities—like pulling strongly on a lawn mower starter cord—can injure the extensor muscle fibers and lead to a sudden onset of tennis elbow.

More commonly, though, symptoms of tennis elbow develop gradually over a period of weeks or months as a result of repeated or forceful use of the wrist, hand, and elbow. If you work as a grocery store cashier, you might have symptoms of tennis elbow as a result of repetitive (and often too forceful) typing—combined with continuous lifting of grocery bags.

Your symptoms may include:

• Pain that radiates into your forearm and wrist
• Difficulty doing common tasks, such as turning a doorknob or holding a coffee cup
• Difficulty with gripping activities
• Increased pain when you use your wrist and hand for lifting objects, opening a jar, or gripping something tightly, such as a knife and fork
• Stiffness in the elbow
• Weakness in the forearm, wrist, or hand

How Is It Diagnosed?

Tennis elbow usually occurs due to repeated movements. As a result, other muscles and joints in this region of the body may be affected as well. Your physical therapist will perform a careful examination not only of your elbow but of other areas of your body that might be affected and might be contributing to your pain. Your therapist will perform special manual tests that help diagnose the problem and help detect conditions such as muscle weakness that might have led to the problem in the first place. For instance, the therapist might ask you to gently tense or stretch the sore muscles to identify the exact location of the problem. Rarely is an x-ray required to diagnose this condition.

How Can a Physical Therapist Help?

The First 24 to 48 Hours

For the first 24 to 48 hours after acute onset of your pain, treatment includes:

• Resting the arm by avoiding certain activities and modifying the way you do others
• Using 10-20 minute ice treatments
• Using elastic bandages or supports to take the pressure off of the painful muscles

Your physical therapist will decide if you should use a brace or support to protect your muscles while the area is healing. Depending on severity, your therapist may recommend that you consult with another health care provider for further testing or for consideration of additional treatment such as medication. In rare cases, treatments such as cortisone injection or surgery might be needed. Your physical therapist can help you determine whether you need a referral to another health care provider.

Your physical therapist can design a specific treatment program to speed your recovery. There will very likely be exercises and other treatments that you will be expected to do at home. Your physical therapist also might use special physical therapy treatments to help relieve pain, such as manual therapy, special exercises, and ice or heat treatments or both.

For an “acute” case of tennis elbow—one that has occurred within the past few weeks— it’s important to treat as early as possible. Left untreated, tennis elbow may become chronic and last for months and sometimes even years. This is especially true if treatment is focused only on relieving pain and not on correcting the muscle weakness and bad habits that might have led to your condition in the first place.

Improve Your Ability to Move

Your physical therapist may use manual therapy to enable your joints and muscles to move more freely with less pain.

Improve Your Strength

Insufficient muscle strength can lead to tennis elbow. Sometimes the weakness is in the muscles of the wrist and forearm. In many cases, the problem stems from weakness of the supporting postural, or “core,” muscles. In fact, you might find that it is necessary to improve your overall level of fitness to help manage your elbow condition. Based on the evaluation, your physical therapist can determine the type and amount of exercises that are right for you.

Physical therapists prescribe several types of exercises during recovery from tennis elbow:

• Early in the treatment, when the pain is most intense, your therapist may recommend passive exercises in which your wrist and elbow are moved without the use of your muscles.
• As your symptoms improve, you can move the wrist and elbow actively without assistance.
• As the muscles become stronger and the symptoms have lessened, you will be able to begin using weights or resistance bands to further increase your strength. The amount of weight will need to be carefully monitored to make sure you continue to progress and avoid re-injuring your muscles.

Use Your Muscles the Right Way

Your physical therapist can help you retrain your muscles so that you use them properly. For example, when you lift a heavy grocery bag, you should contract the muscles around your shoulder blade and trunk to provide support for your arm muscles. This simple movement can be easily taught to you by a physical therapist can lessen the stress to the injured muscles and help you return to your normal activities while avoiding re-injury.

Return to Your Activities

Your physical therapist will help you remain active by teaching you how to modify your daily activities to avoid pain and further injury. Sometimes it’s necessary to make changes at work, on the playing field, or in the home. Your physical therapist can help you make simple modifications to your work site, your computer set-up, your kitchen devices, your sports equipment, and even your gardening tools to lessen the strain to your hand, wrist, and forearm. Your therapist will emphasize the importance of taking stretch breaks so that your muscles get frequent rest from repetitive movements and standing or sitting in the same position.

Tennis may be a contributing factor to tennis elbow for several reasons. Sometimes the problem results from over-training. In other cases, the weight of the racquet or its grip may need to be adjusted. For others, the problem may stem from improper form, poor overall fitness, or a lack of strength in the supporting or “core” muscles of the trunk and shoulder blades. A physical therapist can help analyze the source of the problem and help find a solution.

Can This Injury or Condition Be Prevented?

Yes! You can help prevent tennis elbow by staying fit, using proper technique in your sport or in your job, and using equipment that is well designed and appropriate for your body type and your level of activity. Your physical therapist can show you how. If you had tennis elbow years ago, you might be at risk for re-injury if the tendons did not have time to completely heal or if your muscle strength and joint mobility were not fully restored. Returning to sports or activities before you have fully recovered might result in an elbow that has persistent pain or is easily or frequently re-injured. A physical therapist can help determine when you are ready to return to your activities and sports and can help make sure that your elbow, forearm, and wrist are strong and ready for action.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat a variety of conditions or injuries. You may want to consider:

• A physical therapist who is experienced in treating people with musculoskeletal problems.
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopaedics physical therapy. This therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you’re looking for a physical therapist (or any other health care provider):

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with tennis elbow.
• During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and say what makes your symptoms worse.

Find a PT Near You!

Further Reading

The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for their visit with their health care provider.

The following articles provide some of the best scientific evidence related to physical therapy treatment of below-knee amputation. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.

Weber C, Thai V, Neuheuser K, et al. Efficacy of physical therapy for the treatment of lateral epicondylitis: a meta-analysis BMC Musculoskelet Disord. 2015 Aug 25;16(1):223. Pubmed Abstract.

Shiri R, Viikari-Juntura E, Varonen H, Heliövaara M. Prevalence and determinants of lateral and medial epicondylitis: a population study. Am J Epidemiol. 2006; 164:1065-74. Pubmed Abstract.

Peterson M, Butler S, Eriksson M, Svärdsudd K. A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci. 2011; 116:269-79. PubMed Abstract.

*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine’s MEDLINE database.

Reviewed by the editorial board.

What are the signs and symptoms of Tennis Elbow?

Signs and symptoms of tennis elbow:

Tennis elbow involves pain at the common extensor belly/tendon and the lateral epicondyle of the humerus. Permission: Joseph E. Muscolino, The Muscle and Bone Palpation Manual, with Trigger Points, Referral Patterns, and Stretching, 2ed. (2016), Elsevier.

The most common symptoms of tennis elbow (lateral epicondylitis, lateral epicondylosis) are pain and tightness at the common extensor belly/tendon, directly distal to the lateral epicondyle of the humerus. This tightness might be global tightness of the entire belly or bellies of the associated muscles, or might manifest as myofascial trigger points (TrPs). The pain will usually occur with contraction of the muscles of the common extensor tendon, whether it is concentric, eccentric, or isometric stabilization contraction. Pain as well as tightness will also be evident with palpation of the proximal bellies of the associated musculature and their proximal common extensor tendon. Pain might also occur when the muscles of the common extensor tendon are stretched; this would occur when the hands and/or fingers are actively or passively moved into flexion. If the tightness of the musculature of the common extensor tendon is sufficient, it might also cause decreased active or passive flexion range of motion of the wrist joint. Due to its role in stabilization of the wrist joint, the most commonly affected muscle with tennis elbow is the extensor carpi radialis brevis.

With continuing overuse, the constant pulling of the common extensor tendon upon its bony attachment will eventually lead to irritation, swelling, and therefore pain at the periosteum of the lateral epicondyle of the humerus. Therefore, even though this condition is technically named for the lateral epicondylar attachment, pain at the lateral epicondyle itself does not usually occur until this condition has progressed to be more chronic and severe.

In the early stages of this condition, in addition to pain, swelling is also usually present at the common extensor belly/tendon and can usually be felt on palpatory examination. The swelling can also spread to the lateral epicondyle and may also be visualized; look for the bony contours of the lateral elbow to be less evident compared to the other side of the patient’s/client’s body. In later stages of this condition, usually after a period of six months or more, the swelling gradually recedes and degeneration of the collagen construct of the common tendon occurs. As this transition in pathophysiology occurs, the description of this condition changes from lateral epicondylitis to lateral epicondylosis (as previously mentioned). Due to the degeneration of the tendon and the continued pull of muscular contraction, tearing of the tendon may also occur.

If tennis elbow is left unresolved for a very long time, because its underlying cause is overuse and irritation of the extensor musculature of the posterior forearm, tendinitis of the distal tendons of these muscles at the wrist joint is a possible consequence.

Click here for an article on the signs and symptoms of golfer’s elbow.

Note: This is the second of five blog post articles on tennis elbow.

The five articles are:

1. What are the causes of Tennis Elbow?
2. What are the signs and symptoms of Tennis Elbow?
3. How do we assess (diagnose) Tennis Elbow?
4. How do we treat Tennis Elbow with manual therapy?
5. What are the self-care and medical approaches to Tennis Elbow?

90,000 Epicondylitis (tennis elbow, golfer’s elbow) – treatment, symptoms, causes, diagnosis

Lateral and medial epicondylitis are similar diseases, localized in the upper extremities. Epicondylitis causes pain and functional impairment and usually results from certain physical activity associated with professional and sports activities. Lateral , originally described by Morris as “tennis elbow” in 1882.Currently, “tennis elbow” can occur in people when performing any activity that is accompanied by repeated flexion and extension of the forearm at the elbow with stress. Medial , commonly referred to as “golfer’s elbow”, can occur in athletes, discus throwers, tennis players, and workers in repetitive occupations (eg carpenters). Lateral epicondylitis occurs 7-10 times more often than medial epicondylitis. Both types (lateral and medial) are most common between the ages of 40 and 50, both in women and men.

Lateral epicondylitis is most often the result of repetitive microtrauma, but may result from direct trauma. It is quite common among tennis players, especially non-professionals, in whom the lack of normal technique of movements is a provoking factor. Lateral epicondylitis is caused by repetitive contractions of the extensor muscles of the extensor forearm, especially at the insertion site, resulting in micro-ruptures followed by degeneration, insufficient regeneration, and, as a consequence, tendinosis.The lack of vascularization on the inferior surface of the tendon further contributes to degeneration and tendinosis.

Initially, it is believed that the disease arises from an inflammatory process involving the radial humeral bag, synovium, periosteum and annular ligament. In 1979, Nirschl and Pettrone described their observations as disorganization of the normal architecture of collagen by fibroblasts, which, with insufficient vasculature in this area, cause a process they called angiofibroplastic hyperplasia, later described as “angiofibroplastic tendinosis.”Over time, scar tissue from these processes replaces normal tissue, which further weakens the tissue and puts it at greater risk of damage. The continuation of this cycle of injuries and imperfect regeneration impair biomechanics, disrupt muscle function and lead to symptoms.

Epicondylitis is a degenerative-dystrophic process with the involvement of the extensor tendons in the lateral and the tendons of the flexor-pronator muscle group in the medial. It is believed that systematic stress leads to tendinosis.Microtrauma and partial tears can lead to significant thickening of the tendon. The diagnosis is made on the basis of a thorough history of physical and instrumental examination. In most patients, it is possible to relieve the inflammatory process by prescribing a short course of NSAIDs and using orthoses. Treatments also include injections of autologous blood or platelet-rich plasma, extracorporeal shock wave therapy, iontophoresis and phonophoresis with drugs that penetrate deep into tissues.

In addition, the rehabilitation program includes measures that contribute to a gradual increase in muscle strength, elasticity and functionality in order to restore the ability to work or the ability to continue playing sports. In rehabilitation, it is important to eliminate any biomechanical disorders that could lead to the initial trauma.

While conservative treatment is often successful, sometimes there is a need for instrumental examination methods, such as MRI or ultrasound.These studies are necessary to verify the presence of calcifications, the degree of tendon damage, the presence of bone growths and when planning surgical treatment. Differential diagnosis is sometimes necessary for lateral epicondylitis with fracture, osteoarthritis, tunnel syndrome. If medial epicondylitis is suspected, medial osteoarthritis, medial ligament injury, and ulnar neuropathy should be ruled out, although these conditions may occur concurrently with epicondylitis.

Symptoms and Diagnosis

Patients with lateral epicondylitis are characterized by the presence of pain in the elbow, which increases when the weight is held in the arm during extension. Playing tennis or similar athletic movements can actually cause epicondylitis, but it is often associated with other activities. On palpation in the area of ​​attachment of the tendons, about 1 cm distal to the middle part of the epicondyle, compaction and soreness are noted. In addition, there is a decrease in muscle strength with resistance to grip and with supination of the hand.There are also tests such as chair lift (with arm pronation) and coffee cup test (in which the patient lifts a full cup of coffee). Elbow pain usually occurs with these tests. The diagnosis of lateral epicondylitis is usually clinical. Epicondylitis can be moderate or severe in degree.

With medial epicondylitis, pain is localized in the medial part of the elbow. Symptoms (pain) develop gradually in patients with medial epicondylitis (except for acute trauma).Muscle weakness during grasping is also noted. Patients may have a history of golf, basketball, volleyball. On palpation in the area of ​​flexor-pronator tendons (5-10 mm and distal to the middle part of the medial epicondyle), induration and soreness are noted. In addition, the pain is exacerbated by the resistance of the wrist to flexion of the forearm and pronation at a 90 ° angle. Flexion contractures can develop in professional athletes due to muscle hypertrophy. It is necessary to differentiate medial epicondylitis with tunnel syndrome and ulnar neuritis.There is a simple “milking” test (simulated milking), which causes increased pain in medial epicondylitis.

However, sometimes there is a need for instrumental diagnostics (imaging) for differential diagnosis with other diseases. It is noted that 5% of people with a primary diagnosis of lateral epicondylitis have radial tunnel syndrome. Radial tunnel syndrome is compression of the posterior interosseous nerve (deep branch of the radial nerve) in the radial tunnel.Many patients with this syndrome have a history of activity associated with frequent pronation and supination of the forearm. The most common finding on MRI in radial tunnel syndrome is edema, denervation, or atrophy in the muscles innervated by the posterior interosseous nerve.

MRI – diagnostics helps to make an accurate diagnosis. But normal visualization is possible only on high-field devices (magnetic field strength is 1 Tesla or more).

Ultrasound is a rather informative research method that allows visualizing this pathology.

EMG – the study is necessary only for signs of conduction disturbances (with tunnel syndromes and neuritis).

Treatment of epicondylitis

Treatment of epicondylitis is mainly conservative: the use of orthoses during exacerbation and at night, shock wave therapy, ultrasound therapy or galvanization, sometimes local administration of corticosteroids, drug treatment (NSAIDs). In addition, exercise therapy is needed to restore function (a gradual increase in the load on the forearm).Conservative treatments are effective in 90% of cases. In the absence of the effect of conservative treatment within 3-6 months, surgical treatment is recommended.

90,000 Tennis Elbow: Treatment for Tennis Elbow

Treatment for tennis elbow is mostly conservative. Since any stress and tension in the muscles causes pain, rest is recommended. In some cases, if the pain syndrome is not pronounced, self-massage is prescribed in the muscle area, applying dry heat.In case of severe pain, a plaster cast is applied to the arm for 3 – 5 weeks, or the arm is suspended from a scarf. Non-steroidal anti-inflammatory drugs are prescribed: diclofenac, ibuprofen, indomethacin and others. Positive results can be achieved with the use of physiotherapy procedures. The most effective for this disease are sinusoidal simulated currents, ultrasound and laser.

To relieve acute pain and inflammation, solutions of glucocorticoid hormones or local anesthetics are injected into the area of ​​the focus: lidocaine and novocaine.

Treatment for tennis elbow depends on factors such as the patient’s age, general health, severity of pain, and the medications they have previously taken. The main goal in the treatment of this disease is to reduce the load on the elbow, relieve pain and inflammation, as well as complete recovery and strengthening of the affected elbow. Therefore, in order for the treatment to be as effective as possible, you should consult an experienced specialist at the first symptoms of the disease.

First of all, if you have a tennis elbow disease, the doctor will recommend you to minimize the stress, and also prescribe the methods of treatment that are suitable in your case. To cure tennis elbow, you may be offered acupuncture treatments as well as pharmacopuncture treatments that improve blood flow to the joint. Electrophoresis, phonophoresis, shock wave therapy, therapeutic massage are also used. An elastic bandage may be used to keep the affected arm at rest. After the pain has passed, the patient can gradually move on to physical therapy, and then, slowly, return to normal daily activities.

After removal or reduction of pain in the elbow, the patient can independently accelerate his recovery at home. It is allowed to perform simple physical exercises aimed at strengthening and stretching the tendons and muscles that surround the elbow.

The prognosis of tennis elbow treatment is generally good in 90 – 95% of cases. Only in 5% of all cases, conservative treatment does not help and one has to resort to surgical intervention.

What are tennis elbow and golfer’s elbow?

What is tennis elbow and golfer’s elbow

Tennis elbow is the common name for lateral (external) epicondylitis, i.e.e. inflammation of the tendons located on the outer surface of the elbow joint. If epicondylitis occurs on the inside of the elbow, it is called a golfer’s elbow. Tennis elbow is more common than golfer’s elbow.

Tennis elbow and golfer’s elbow are not the typical inflammation that was previously thought. Rather, it is a local painful irritation of the site of attachment of the tendon to the bone.

Two types of epicondylitis

Golfer’s elbow (pain on the inner surface)

Tennis elbow (outer pain)

Tennis elbow and golfer’s elbow: causes and risk factors

All the muscles of the forearm involved in the movement of the fingers and hand are attached to the humerus at two points, the external and internal epicondyle.Overloading these muscles leads to microscopic tears, including in the tendons.

Sports loads and prolonged bent position of the elbow joints (even without effort) can cause epicondylitis. In everyday life, epicondylitis can develop in people who work a lot at the computer and when doing manual work with arms bent at the elbows.

Symptoms of epicondylitis

Pain in the elbow joint occurs with muscle tension.With a tennis elbow, the pain is localized on the outer surface of the elbow joint, and with a golfer’s elbow – on the inside.

The greater the effort of the muscles of the forearm, the more intense the pain. The pain can spread to the shoulder and forearm. In addition, there may be complaints about the appearance of weakness of the fingers.

Initially, pain occurs only with muscle contraction (clenching a fist, gripping with a hand, lifting weights, etc.). As the disease progresses, pain is felt at rest.

Prevention of epicondylitis

Observe the correct biomechanics of movements in the elbow joint:

• Play tennis with correct technique.If necessary, attend a special briefing.
• Use the ergonomic mouse and keyboard while working at the computer to relieve tension on the muscles in your forearm.
• If you are doing manual work, use the cordless tool.
• When lifting heavy objects, keep your palms facing up.
• Dose exercise and take regular breaks.

Treatment of epicondylitis

First, it is necessary to change the biomechanics of the elbow joint, as during sports or work, in order to eliminate the cause of the pain.In this case, treatment measures will quickly help get rid of the pain.

• Bandages. To relieve the condition, many doctors first recommend the use of elbow braces. Compression tying and 3D silicone inserts work effectively on muscles and tendons to reduce pain.
• Bandages. medi has developed a special medi Epibrace dressing for the treatment of epicondylitis. The dressing has a special insert that reduces tendon tension and smooths out peak loads.
• Surgical treatment. Surgical treatment is rarely used to treat epicondylitis, since conservative therapy is effective in most cases.
• Stretching exercises. Performing eccentric exercises (flexion, wrist stretching and forearm stretching) provides significant relief and recovery for many patients. Regular stretching exercises reduce the tension on the tendons.
• Strength training exercises. Strength training complexes help cure epicondylitis.
• Heat and cold can help in the treatment of epicondylitis. In the acute phase and immediately after intense exertion, cooling compresses should be applied. Exposure to heat helps in the treatment of chronic epicondylitis.
• Massage. Special massage (deep kneading), as physiotherapy methods, stimulates blood circulation.
• Shockwave therapy. If epicondylitis is difficult to treat or calcifications are found in the tendons, extracorporeal shock wave therapy may be used.Its use helps to start the repair processes inside the tendon.
• Acupuncture sessions, injection blocks, and pain relievers may also be effective.

Complex of exercises for epicondylitis

For medial (golfer’s elbow) or lateral (tennis elbow) epicondylitis, both eccentric exercises and strength training exercises are effective.For the greatest effect, exercise should be done 3-4 times a week.

Be sure to ask your doctor if this particular set of exercises is right for you.

Tennis Elbow Exercises

Tennis Elbow: Strength Training

Equipment

• not required
• Exercise seated

Home position

• Sit on a chair next to the table.
• Place the forearm of the affected hand on the table surface so that the hand can be flexed and extended freely.
• The back of the hand should be on top.
• Make a fist.
• Extend the clenched hand as much as possible.
• Place your healthy hand on the back of your fist.

• With your good hand, apply moderate pressure to the back of your clenched fist.
• Slowly (like in slow motion) give in to the force and bend your fist.
• Mild pain is permissible at the time of exercise.

• The pressure should be metered so that the trained arm can bend slowly.
• Movement must be slow and controlled.

Frequency

• 3 sets of 15 reps
• break between sets 30 seconds

Tennis Elbow Stretching Exercise

Equipment

• not required
• Exercise seated

Home position

• Stand up straight and extend the affected arm straight out in front of you.
• The angle between the arm and the torso should be 90 degrees.
• The arm must be extended (extended).
• The back of the hand should be on top.
• Make a fist.
• Place your free hand in your fist.

Exercise

• Bend the affected arm at the wrist joint as much as possible.
• Apply moderate pressure with your good hand to create a tension sensation in the extensor muscles of the forearm.
• To enhance the stretching effect, you can slightly rotate the affected arm outward.

Frequency

• 3 sets for each arm, 20 seconds
• 30 second break between sets

Golfer Elbow Exercises

Golfer’s Elbow: Strength Training

Equipment

• not required
• Exercise seated

Home position

• Sit on a chair next to the table.
• Place the forearm of the affected hand on the table surface so that the hand can be flexed and extended freely.
• The palm should be facing up.
• Bend the hand in a fist as much as possible.
• Place the palm of the healthy hand on the palm of the affected hand.

Exercise

• With your healthy hand, apply moderate pressure to the palm of your affected hand.
• Slowly (like in slow motion), unbend the palm of your injured hand.

Note:

• Fingers and palm should always be in the same plane.
• The pressure should be dosed so that the affected hand slowly yields to the force acting on it.
• The healthy hand should cover all the phalanges of the fingers of the other hand.
• Movement must be slow and controlled.

Frequency

• 3 sets of 15 reps
• break between sets 30 seconds

Golfer’s Elbow: Strength Training

Equipment

• not required
• Exercise seated

Home position

• Stand up straight and extend the affected arm straight out in front of you.
• The angle between the arm and the torso should be 90 degrees.
• The arm must be extended (extended).
• The palm of the hand should be on top.
• Place the palm of the healthy hand on the palm of the affected hand.
• The healthy hand should cover all the phalanges of the fingers of the other hand.

• Extend the affected arm at the wrist joint as far as possible so that the fingertips are pointing forward and downward.
• Apply moderate pressure with your good hand to create a tension sensation in the flexor muscles of the forearm.

• 3 sets of 20 seconds for each arm
• 30 second break between sets

Medi products for the treatment of epicondylitis

medi products shorten the treatment time for epicondylitis

• medi elbow bandages
• medi elbow bandages

Diagnostics and treatment

Causes and symptoms of joint problems

Joint pain

Human body

Ligament damage often occurs during sports.

Tendons and ligaments

90,000 Tennis elbow: description of the disease, causes, symptoms, cost of treatment in Moscow

When the tissues in the elbow joint are affected, and the process is inflammatory-degenerative in nature, it is called epicondylitis or tennis elbow.The development of the disease occurs in the place where the tendon of the forearm attaches to the epicondyle of the shoulder bone. The main cause of epicondylitis is the presence of chronic overload of the muscles of the forearm.

This disease is characterized by a pathological process in the bone of the periosteum, tendons. The external and internal condyle falls under the lesion. As a result, styloiditis develops, and painful sensations arise in the place where muscle tendons attach, which abduct and extend the thumb.

Given the localization, epicondylitis can be external and internal. Outside happens several times more often and, mainly, men suffer from it. If the person is right-handed, the right hand will be damaged, if the person is left-handed – the left. If we talk about the age range, the disease appears in the period from 35 to 55 years. The likelihood of the appearance of the disease in those people whose activities are associated with the constant repetition of the same monotonous movement (driver, athlete, pianist, tennis player, etc.)).

Why does the disease appear

The development of the disease is characterized by degenerative changes in the joint, which are the cause of the inflammatory process. The provoking factors include:

1. what is the main work of a person.

2. the presence of regular microtraumas or direct injuries of the elbow joint.

3. chronic overload of the joints.

4. impaired local blood circulation.

5. cervical or thoracic osteochondrosis, osteoporosis, humeroscapular periarthritis.

In most cases, the diagnosis of epicondylitis is made by a person who repeats a certain movement with his hands: pronation (the forearm turns inward, palm down), supination (outward turn, palm up). The risk group includes:

• agricultural workers (tractor drivers, milkmaids).

• Builders (bricklayers, plasterers, painters).

• Athletes (boxers, weightlifters).

• Doctors (surgeons, masseurs).

• Musicians (pianists, violinists).

• Service workers (hairdressers, ironers, typists).

In fact, the above occupations are not the cause of epicondylitis.The disease appears when the muscles of the forearm are overloaded, as a result of which the appearance of systematic microtraumas of the periarticular tissue is observed. Therefore, the development of an inflammatory process occurs, the appearance of small scars, as a result of which the resistance of the tendon to stress decreases. In addition, high muscle tension is the reason that the number of microtraumas increases.

There are situations when the occurrence of epicondylitis is associated with direct injury, congenital weak ligamentous apparatus, a single intense muscle strain.In addition, epicondylitis is associated with osteochondrosis, osteoporosis, periarthritis, dysplasia, and impaired blood circulation.

How to recognize epicondylitis

General symptoms are as follows:

• The appearance of spontaneous intense and burning painful sensations in the elbow joint. Such pain is further transformed into dull and aching.

• The painful sensations increase during physical exertion on the elbow or when the muscles of the forearm are strained.

• Muscle strength is lost in the affected limb. This happens gradually.

Lateral epicondylitis is characterized by the spread of painful sensations to the outer surface of the elbow joint. An increase in pain will occur if you unbend the wrist, rotate the wrist. There is certain testing – the coffee cup. If a person tries to take a cup from the surface of the table into which a liquid is poured, he will notice that the pain has begun to intensify.In addition, an increase in pain intensity will occur if the forearm is turned outward.

The localization of pain during medial epicondylitis is the inner surface of the elbow joint. Increased pain occurs when the forearm is flexed or resisted when the wrist is passively flexed. Soreness can be transmitted through the internal muscles of the forearm to the hand. The motor range of motion of the joint will be sharply limited.

There is an acute, subacute and chronic stage of the disease.At first, the pain is accompanied by a sharp or short-term muscle tension, then it will become constant. The muscles of the affected limb will quickly tire. The acute stage is characterized by a decrease in the intensity of the pain syndrome, and if the hand is kept at rest, the pain will disappear. In the chronic stage, remissions and relapses alternate. The time frame ranges from three to six months.

Varieties of the disease

Given the localization of epicondylitis, be external, external (tendons that attach to the external epicondyle are damaged), internal (the tendon that goes from the internal epicondyle becomes inflamed).

With external or lateral epicondylitis, the inflammatory process is observed in the place where the muscle tendons attach to the external epicondyle of the bone. The appearance of this problem is typical for those who constantly overextend their extensor muscles. This type of disease can be determined with the help of certain testing. It is called a handshake symptom. When shaking hands, the person will experience pain. In addition, painful sensations will arise if you turn the hand so that the palm is up, or straighten the forearm.

With medial or internal epicondylitis, the area under the lesion is where the muscle tendons attach to the inner epicondyle of the bone. A distinctive feature of this type of epicondylitis from the external one is the lighter loads, which caused the disease. The implementation of monotonous stereotyped movements occurs with the help of the wrist flexor muscles.

In most cases, painful sensations appear if you press on the inner epicondyle, bend the forearm.Internal epicondylitis is characterized by a chronic form. In addition, the ulnar nerve is affected.

With traumatic epicondylitis, which occurs due to systematic minor injuries when performing the same type of action, deformation of the elbow joint occurs, and also, the ulnar nerve is affected and the development of cervical osteochondrosis is observed. In a person who is over 45 years old, there is a decrease in the ability to regenerate tissue, therefore, the disturbed structure will be slowly replaced by connective tissues.

Another type of epicondylitis is post-traumatic. Its development occurs as a result of the resulting stretching or dislocation of the joint, as well as if a person poorly adheres to medical recommendations during the rehabilitation period and is in a hurry to move on to intense loads on the joint.

In the chronic form, which is characteristic of such a disease, for a long time (change of exacerbations and relapses), the painful sensations will become weak, aching. In addition, muscle strength will be lost, as a result of which a person will lose the ability to take even light objects in his hand.

How to diagnose epicondylitis

To diagnose such a disease, a person must first be interviewed, examine the history data and visually look. If we talk about another destructive lesion of the elbow joint, then a distinctive feature of epicondylitis is the specificity of painful sensations. This disease is characterized by the appearance of pain syndrome when a person independently loads the joint. When the doctor makes various movements of the affected limb of the patient (this is called passive flexion and extension), painful sensations will not appear.This is the difference between epicondylitis and diseases such as arthritis, arthrosis.

Testing is another diagnostic measure. For example, in the Thompson test, the victim squeezes the hand. She will quickly turn around, move to the position where the palm is up. To identify the welta symptom, it is necessary to fix the forearm so that it is at the same level with the chin, and simultaneously extend and flex the arm. These actions, which the diseased hand will perform, will lag behind those performed by the healthy hand.When performing these tests, a person experiences severe pain.

As for the treatment of epicondylitis

If a person has weak painful sensations, it is necessary, if possible, not to make various movements that are a provocateur of a painful syndrome. It happens that professional activity or sports activities involve heavy loads on the muscles of the forearm. In such a situation, it is recommended to leave the elbow joint alone for a while.In addition, it is necessary to determine and get rid of the cause of such overloads. It is possible to change the technique of performing a specific movement. When painful sensations disappear, it is recommended to perform minimal loads with their gradual increase.

If the disease is chronic and there are frequent relapses, the patient is advised to change activities or stop playing a certain sport. If the pain syndrome is pronounced and the acute stage of the disease has begun, it is necessary to immobilize the joint for a short time.For this, plaster or plastic splint is used. Immobilization lasts approximately 7 days. After removing the splint, it is allowed to apply a warming compress (camphor alcohol, vodka). The chronic stage of the disease requires fixation of the joint and forearm with an elastic bandage. Fixation takes place in the daytime, the bandage is removed before bedtime.

Given that painful sensations are a consequence of the inflammatory process, the patient is prescribed non-steroidal anti-inflammatory drugs.They are presented in the form of an ointment (use of diclofenac, nurofen, indomethacin, nimesil, ketonal, nise).

If a person has very severe, unrelenting pain, blockade with corticosteroids (hydrocortisone, methylprednisolone) is performed. They are injected into the inflammatory focus. It should be remembered that within 24 hours the pain will intensify.

If not
use glucocorticosteroids, conservative treatment will eliminate pain in
within 15-20 days.If a drug block is given, the pain will disappear after
two to three days. An additional measure in the treatment of the disease is the appointment
aspirin, butadione. To change the trophism of tissues, a blockade can be prescribed,
when using bidistilled water. It is painful but
effective procedure.

Treat tennis elbow with a laser. Treatment of epicondylitis at home – ORION devices.

Indicate your main disease

Joint diseases:
arthrosis, gonarthrosis, coxarthrosis, osteoarthritis deformans, arthritis, rheumatoid arthritis, periarthritis, bursitis, tendovaginitis, epicondylitis (tennis elbow), gout, heel spur

Diseases of the spine:
Osteochondrosis, protrusions, herniated intervertebral discs, cervicobrachial sciatica, plexitis, thoracic sciatica, lumbosacral radiculitis, sciatica

Cardiovascular diseases:
hypertension, arrhythmia, cardialgia, angina pectoris, cardiomyopathy, ischemic heart disease (IHD), heart failure, consequences of a heart attack

Diseases of the nervous system:
neuritis, neurosis, neuralgia, pain syndromes, sciatica, migraine, headaches, including meteorological, cerebrovascular insufficiency, stroke consequences, shingles, herpes and postherpetic pain, VSD

Diseases of veins and arteries:
varicose veins, thrombophlebitis, trophic ulcers, atherosclerosis, obliterating endarteritis, diabetic angiopathy of the legs

Injuries and post-traumatic complications:
dislocations, sprains, ligament ruptures, fractures, bone fractures, bruises, hematomas, deep wounds, animal bites, abscess, panaritium, furunculosis, phlegmon, bedsores, burns, complications of frostbite, postoperative

ENT diseases:
rhinitis, sinusitis, sinusitis, otitis media, tonsillitis, tonsillitis, pharyngitis, rhinopharyngitis, laryngitis, laryngotracheitis, hoarseness, hoarseness, loss of voice

Broncho-pulmonary diseases:
ARVI, influenza, bronchitis, tracheobronchitis, catarrh of the upper respiratory tract, pneumonia, bronchial asthma

Urological diseases:
prostatitis, benign prostatic hyperplasia (BPH, prostate adenoma), urinary incontinence, enuresis, cystitis, urethritis, balanitis, balanoposthitis, genital herpes, urolithiasis diathesis, pyelonephritis

Sexual Disorders:
Erectile Dysfunction, Premature Ejaculation, Delayed Ejaculation, Retarded Ejaculation, Orgasm Inhibition

90,000 Tennis Elbow Syndrome.What it is? And how to treat it? | Medical Tourism Agency

In sports medicine, this disease is called lateral epicondylitis, which is also called Tennis Elbow Syndrome. Tennis elbow syndrome got its term due to the fact that professional tennis players are often susceptible to this disease.

It is known that micro tears, which occur with increased stress on the tendons of the elbow joint, which attach to the external epicondyle, are the cause of Tennis Elbow Syndrome.And constant increased loads lead to the formation of new and new minitrauma, which does not allow the tendon to recover, and aggravate lateral epicondylitis or the so-called tennis elbow syndrome.

Age in the period from 40 to 60 can also be the cause of the development of Tennis Elbow Syndrome. At this time, significant hormonal processes take place in the body, which directly affect the state of human bone, cartilage and soft tissues.

But tennis elbow syndrome is diagnosed not only in people who are actively involved in sports.Any repetitive monotonous movements that overstrain a certain muscle group of the arm can provoke this disease. Therefore, people who are far from sports suffer from lateral epicondylitis. it can be a cashier operator, a milkmaid, an office worker, and many other professions whose work is associated with constant tension of the tendons of the hands and forearms.

To identify this syndrome, it is necessary to undergo an examination, in which it is necessary to exclude other possible diseases that can cause pain in the elbow joint.For example: arthritis, pinched nerve, aseptic necrosis of the joint, osteochondrosis of the spine.

Tennis Elbow – Conservative Treatment

In most cases of lateral epicondylitis or tennis elbow syndrome, patients are prescribed conservative treatment and rehabilitation procedures.

During this treatment:

• The patient needs to limit the load on the elbow joint.
• In the acute phase, stress on the joint is excluded altogether
• The patient is prescribed massage and physiotherapy procedures.
• Oral medications are also prescribed.
• Injections may be prescribed.
• It is necessary to wear a special orthopedic device Cut.
• Under the supervision of physiotherapists and rehabilitation therapists, patients are given physical therapy with a gradually increasing load.
• Elbow taping is also usually done. Special plasters are applied to regulate the stress on the joints and tissues.
• Sometimes athletes are advised to change their tennis technique and replace the tennis racket with a model with different ergonomic characteristics.

Surgical treatment of tennis elbow syndrome

In difficult and advanced cases, conservative treatment will not bring the desired result. Therefore, the patient undergoes surgery. There are different types of such operations, but most often they resort to arthroscopic surgery according to the Hohmann method. During such an operation, extensor tenotomy is performed, the bones in the joint are cleaned and smoothed, the cause of irritation and chronic inflammation is removed.

This operation is indicated for violation of the articular surfaces of the elbow joint and for damage to the periarticular tissues, including Tennis Elbow Syndrome, tendon inflammation and epicondylitis.

We highly recommend that you pay attention to how these operations are carried out in the Czech Republic. The skills and experience of doctors and surgeons are here at the highest world level. The provision and equipment of clinics is also excellent. At the same time, the cost of treatment here is several times cheaper than in countries such as Germany, Israel, USA, etc.

What is included in the package of surgery for arthroscopy of the elbow joint in the Czech Republic:

• Preoperative consultation based on the provided visual medical documentation (MRT)
• Invitation from the clinic for a Schengen medical visa
• Airport transfer
• Preoperative examination (therapist , laboratory tests, X-ray)
• Hospitalization in a single room with all conveniences (2-3 days)
• Operation (about 20 minutes) under local anesthesia
• Three meals a day in the clinic with a choice of dishes
• Medicines, consumables and fixation
• Final examination and specialist consultations
• Transfer to the airport
• Accompanying the Russian-speaking medical concierge – visit every working day, escort during the transfer, examinations, doctor’s visits and surgery

Cost of the elbow arthroscopy program according to H OHMANN – 3474 €

The price is fixed and excludes unexpected “surprises” for the patient upon arrival at the clinic or after the operation.

Rehabilitation after surgery

After any orthopedic surgery, the recommendations of surgeons and rehabilitation doctors should be followed. The correct rehabilitation program is the key to the success of the previous operation. Do not neglect the opinion of doctors and rely on the fact that the body will cope on its own. Following the recommendations of the therapist and continuing the physiotherapy procedures, patients accelerate the healing process and consolidate the results of the surgical intervention.

Find out how to get a consultation with surgeons at a clinic in the Czech Republic. Write your questions and we will contact you as soon as possible.

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Tennis elbow / Lateral epicondylitis

Tennis elbow / lateral epicondylitis is caused by an overload of the stretching muscles of the wrist (wrist extensors). Tennis elbow / lateral epicondylitis can significantly affect quality of life and job satisfaction.

Cause of tennis elbow / lateral epicondylitis?

Tennis elbow / lateral epicondylitis is often caused by repetitive movements such as computer work, drawing, and the like. Treatment for tennis elbow / lateral epicondylitis includes addressing the causative cause, eccentric training of the muscles involved, and pressure wave and / or laser treatment. It is the wrist extensors that cause the condition of tennis elbow / lateral epicondylitis (among others, radial wrist extensor or carpi extensor ulnaris myalgia / miosis).

Lateral epicondylitis – tennis elbow – Image Wikimedia

The image above illustrates the damage to lateral epicondylitis. Small micro-fissures develop at the site of attachment of the muscle / tendon to the lateral epicondyle (which you will find on the outside of the elbow), which can often deteriorate due to the continuation of the causal cause, making it difficult for your own healing process to take action. In such cases, external assistance from a physiotherapist, chiropractor, or chiropractor is required.Treatment usually consists of eccentric training combined with a pressure wave and / or laser treatment, as well as addressing the underlying cause of the problem.

Lateral epicondylitis – definition

Lateral epicondylitis: Extra-articular stagnation located at the beginning of the stretching muscles of the wrist or tendons on the outside of the elbow. Repeated full wrist extension (flexion back) during the workday is the most common cause.

Tennis elbow / lateral epicondylitis symptoms

Pain and tenderness on the outside of the elbow. The pain can also run down to the forearm and get worse with certain movements.

Rigid elbow. The elbow can feel stiff and it can be painful to bind the hand to the fist.

– Crunch in the elbow joint. With such dysfunction, there may be a crackling in the elbow joint.

Weakness in the hands or fingers. Sometimes tennis elbow can cause arm weakness on the affected side.

Illing down to the hand, especially the ring or little finger.

Treatment of tennis elbow / lateral epicondylitis

The best evidence for the treatment of lateral epicondylitis is eccentric exercise (see Exercise it), preferably in combination with a pressure wave and / or laser treatment – other confirmed forms of treatment include mobilization / manipulations in the elbow joint. The standard treatment protocol for tennis elbow is with Shockwave for about 5 treatments, with 5-7 days between courses, so the recovery / rest period should be optimal.

What can I do even for an elbow pain?

1. General exercise, special exercises, stretching and activity are recommended, but stay within the pain. Two walks a day for 20-40 minutes are good for the whole body and muscle soreness.

2. Trigger point / massage balls we highly recommend – they come in different sizes, so you can hit even all parts of the body. There is no better self-help than this! We recommend the following (click the image below) is a complete set of 5 trigger points / massage balls of different sizes:

3. Training: Special training with training techniques of different opponents (for example, this set of 6 matings of different resistances) can help you train strength and function. Knitting training often involves more specific training, which in turn can lead to more effective injury prevention and pain relief.

4. Pain Relief – Cooling: Biofreeze is a natural product that can relieve pain by gently cooling the area.Cooling is especially recommended when the pain is severe. When they have calmed down, heat treatment is recommended – so it is advisable to have both cooling and heating.

5. Pain Relief – Heating: Warming up muscles can improve circulation and reduce pain. We recommend the following reusable hot / cold pad (click here to learn more about this) – which can be used for both cooling (freezing) and heating (microwaveable).

Recommended products for elbow pain relief

Biofreeze (Cold / Cryotherapy)

needle treatment is often used for elbow pain. It can be effective against conditions such as tennis elbow (lateral epicondylitis), golf elbow (medial epicondylitis), and general muscle dysfunction (myalgia). Here you can watch a video of the tennis elbow acupuncture procedure.

Other treatments for tennis elbow / lateral epicondylitis:

– Acupuncture / needle treatment

– Soft tissue work / massage

– Electrotherapy / energy therapy

– Ice treatment –

– Ice treatment –

9000

– Joint corrective treatment

– Muscle ganglion / trigger point therapy

– Ultrasound

– Heat treatment

Recommended products for pain relief for tennis elbow / lateral epicondylitis

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Evidence for the treatment of tennis elbow / lateral epicondylitis

Larger RCT (Bisset 2006), also known as a randomized controlled trial, published in Bree Tang Medical Journal (BMJ), showed that physical treatment of lateral epicondylitis consisting of manipulation of the elbow joint and specific exercises had a significantly greater effect in pain relief and improved functionality compared to waiting and seeking in the short term, and in the long term compared to cortisone injections.The same study also showed that cortisone has a short-term effect, but paradoxically, in the long term, it increases the likelihood of relapse and leads to slower healing of the injury. Another study (Smidt 2002) also supports these findings.

Tennis Elbow / Lateral Epicondylitis Measures

One of the most important things in congestion injuries is that you simply and easily reduce the activity that irritates muscles and tendons, this can be done by making ergonomic changes in the workplace. spot or after resting from painful movements.However, it is important not to stop completely as it does more harm in the long run.

Elbow support is also recommended , We recommend Shock Doctor elbow support .

Elbow Support Image:

Tennis Elbow / Lateral Epicondylitis Training

Grasp Training: Press a soft ball and hold for 5 seconds. Do 2 sets of 15 reps.

Pronation of the forearm and increased supination: Hold a soup box or similar in your hand and bend your elbow 90 degrees. Slowly turn your hand so that it is pointing up, and slowly turn it face down. Repeat 2 sets of 15 reps.

Resistance training for elbow flexion and extension: Hold a soup can or similar object with your hand up. Bend your elbow so that your hand is facing your shoulder. Then lower your arm until it is fully extended.Do 2 sets of 15 reps. Gradually increase resistance as you get stronger.

Tennis Elbow Stretch / Lateral Epicondylitis

Flexion and Extension Wrist Mobilization: Flex the wrist into flexion (forward bend) and extension (backward bend) as far as possible. Do 2 sets of 15 reps.

Wrist Extension: Press down on the back with your other hand to bend the wrist.Hold with adjustable pressure for 15-30 seconds. Then change the movement and stretch, pushing the front of your arm back. Hold this position for 15 to 30 seconds. Remember to keep your arm straight when doing these stretching exercises. Complete 3 sets.

Pronation and supination of the forearm: Bend the elbow on the affected arm 90 degrees, keeping the elbow on the body. Turn your palm upward and hold this position for 5 seconds. Then slowly lower your palm down and hold this position for 5 seconds.Do this in 2 sets of 15 reps each.

Invasive treatment for tennis elbow

– Surgery / surgery

– Pain injection

Tennis elbow / surgery for lateral epicondylitis

tennis elbow / lateral epicondylitis. But due to the risk and the likelihood of deterioration, this is considered a last resort.

Anesthetic injection against tennis elbow / lateral epicondylitis

A treatment option that can be tested before surgery, if conservative treatment is fully tested and pain only persists, then it may be appropriate with an injection in the treatment of tennis elbow / lateral epicondylitis. Cortisone injections are usually the most commonly used, but there are other options. Unfortunately, cortisone injections can lead to increased pain in the long term.This is what you want to try before any surgery.

Learn more in this book: Injection Technique in Musculoskeletal Medicine (for physicians and those in particular)
Book Image:

Eccentric / Lateral Tennis Elbow Exercises epicondylitis

Eccentric training is recommended for the treatment of tennis elbow / lateral epicondylitis.The following video shows eccentric training for lateral epicondylitis.

Did you know that: – Bilberry extract has a proven analgesic and anti-inflammatory effect?

Imaging diagnostic examination of tennis elbow / lateral epicondylitis

Both MRI and diagnostic ultrasound may be helpful in imaging for suspected tennis elbow / lateral epicondylitis.Such imaging tests can usually be dispensed with as the diagnosis and symptoms are usually very clear to the clinician.

MRI image of tennis elbow / lateral epicondylitis

Here we see an MRI image of tennis elbow / lateral epicondylitis. There are obvious reactions around the lateral supracondylar.

Diagnostic ultrasound of tennis elbow / lateral epicondylitis

This ultrasound image shows an increase in muscle attachment to the lateral epicondyle on the outside of the elbow.

Les også:

– Elbow pain

– Did you know Ginger can reduce muscle pain?

Training:

• The Chin / Pull Up Trainer can be a great exercise tool at home. It can be attached and detached from the door frame without using a drill or tool.
• Cross trainer / ellipse machine: Excellent fitness workout.Good for stimulating body movement and exercise in general.
• Rubber Jersey is a great tool for those who need to strengthen the shoulder, arm, body and more. Gentle but effective learning.
• Kettlebell is a very effective form of training that gives quick and good results.
• The rowing machine is one of the best forms of training you can use to get good overall strength.
• Spinning bike ergometer: It’s good to have at home, so you can increase your exercise throughout the year and improve your fitness.

Les også:
– Eccentric exercises in the treatment of lateral epicondylitis / tennis elbow

Les også: – Does your elbow hurt? You must know this!

Les også: – AU! Is it late inflammation or late trauma?

Sources:

1. Bisset L, Beller E, Jull J, Brooks P, Darnell R, Vicenzino B. Mobilization with movement and exercise, corticosteroid injection, or waiting for tennis elbow: A randomized trial BMJ.2006 Nov 4; 333 (7575): 939. Epub 2006 Sep 29.
2. Smidt N., van der Windt D.A., Assendelft V.J., Deville V.L., Cortals de Bos I.B., Bouter L.M. Corticosteroid injection, physiotherapy, or expectant management for lateral epicondylitis: a randomized controlled trial. Lancet. 2002 Feb 23; 359 (9307): 657-62.

Recommended reading:

– Tennis Elbow: Clinical Management (click here to learn more)

Description: Tennis Elbow – Tennis Elbow. A very good book written for an informed approach to tennis elbow syndrome.

“By combining current knowledge and data on the causes and treatment of tennis elbow or lateral epicondylitis, the diagnosis and treatment options for this common sports injury are detailed. Usually attributed to overexertion or repetitive movement of the elbow, tennis elbow causes pain, soreness, and stiffness in the elbow and wrist, even with daily non-sport activities such as lifting and pulling.Starting with its etiology, subsequent chapters explore both conservative and surgical treatments, from physiotherapy, joint injections and acupuncture to arthroscopy, open surgery, and denervation. Outcomes, rehabilitation and return to play are also discussed, as well as methods and indications for the management of complications and re-surgery. Ideal for orthopedic surgeons and sports medicine practitioners, Tennis Elbow: Clinical Management is a practical reference for any clinician treating athletes or active patients. “

– Pain Free: a revolutionary method for stopping chronic pain (click here to learn more)

Description: Painless – a revolutionary method for relieving chronic pain. This very good book was written by the world famous Pete Egoscue, who runs the famous The Egoscue Method Clinic in San Diego. He created exercises, which he called E-Cises, and shows step-by-step descriptions with pictures in the book.He himself claims that his method is successful in 95% of cases. Click her to learn more about his book, as well as see a preview. A book for those who have tried most of the treatments and measures without much success or improvement.

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Frequently asked questions about tennis elbow / lateral epicondylitis

Should I be treated for tennis elbow / lateral epicondylitis?

Yes, if you don’t take action, your condition is likely to only get worse. Seek help from the plague today so you don’t have to carry it with you for the rest of your life. If you cannot afford the treatment, it is best to start with relief measures (elbow support) and individual exercises (see.Earlier in the article).

Should tennis elbow / lateral epicondylitis freeze?

Yes, in situations where it is evident that the attachments to the lateral epicondyle are irritated and possibly even swollen, then icing should be used according to the usual icing protocol. Be careful not to damage fabrics if there is too much cold.

Which pain relievers or muscle relaxants are best for tennis elbow / lateral epicondylitis?

If you are going to take pain relievers without a prescription, then they must be anti-inflammatory, for example ibuprofen or Voltaren . It is not recommended to use pain relievers without eliminating the cause of the pain itself, as this can temporarily hide the pain without any significant improvement in attachment elbow.The doctor can print the prescription muscle relaxants if needed; then most likely tramadol or brexidol .Always consult your doctor or pharmacist before taking any pain relievers.

Craftsman, 44 years old. It works at the elbow when I lift something. What could be the reason?

The cause is most likely due to tennis elbow (lateral epicondylitis) or golf elbow (medial epicondylitis), which can result from repetitive stress (eg carpentry).Tears can occur where muscles attach to the outside or inside of the elbow – both can cause pain when using the arm and wrist. It can also lead to a decrease in grip strength.

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