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Tennis Elbow / Lateral EpicondylitisMichael LaBella

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Objectives

• To understand what tennis elbow is• To understand the anatomy of the elbow• To understand the the muscles and tendons

effected by tennis elbow• To understand how tennis elbow is recognized• To understand how tennis elbow is treated• To understand how tennis elbow can be

prevented

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Definition

Tennis Elbow Defined:– Tennis elbow is an overuse injury of the elbow

joint. It is commonly found in tennis and golf players, especially the “weekend warrior” type. The medical term for tennis elbow is lateral epicondylitis or radiohumeral bursitis

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Anatomy

The elbow joint is made up of the following bones, muscles and ligaments.

• Humerus, Radius and Ulna.

• Bicep and Tricep.

• Lateral and medial epicondyle.

• Wrist flexor and extensor muscles.

• Ulna collateral ligament.

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A Detailed View of the Elbow

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How Tennis Elbow Occurs

As stated earlier, tennis elbow is an overuse injury. The most common mechanism of injury to this joint is continuous forceful extension of the forearm with pronation of the forearm. This movement is most typically seen in the backhand stroke of tennis and in the downswing portion of a golf swing.

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Prevalence

• Tennis elbow is found to have an impact on 1-3% of the general population.

• Most commonly affecting men and women from the ages of 40-50 years of age.

• However, tennis elbow can still present itself in people of all ages who are not properly condition to perform the activities which will tend to cause this injury. Examples are the weekend golf and tennis players who are not commonly active.

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Symptoms and Signs

• Pain along the lateral epicondyle while performing wrist extension against resistance.

• Point tenderness to joint and musculature.

• Inflammation.

• Loss of normal range of motion and function.

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Nirschl Classification of Phases of Lateral Epicondylitis (Tennis Elbow)

PHASES OF PAIN

Phase 0: No pain or sorenessPhase 1: Stiffness or mild soreness after exercise activity. Pain is usually gone in 24 hours.

Phase 2: Mild stiffness and soreness before activity which disappears with warm up. No pain during activity, but mild soreness after activity that disappears within 24 hours.Phase 3: Same as above with mild pain during activity which does not alter activity, disappearing in 24-48 hours. Counterforce bracing may be considered here as well as mild anti-inflammatory medication. Phase 4: Mild to moderate pain before, during, and after exercise which alters the exercise or activity. Phase 4 is indicative of some level of tendon damage.

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Classification Scale Continued

Phase 5: Moderate or greater pain before, during, and after exercise or activity, forcing the patient to discontinue the exercise. Usually reflects permanent tendon damage

Phase 6 Phase 5 pain that persists with complete rest. Pain disrupts and many activities have to be eliminated.

Phase 7: Phase 6 pain with disruption of sleep on a consistent basis. Pain is aching in nature and intensifies with activity.

Pain phases 5, 6, and 7 indicate increasing percentages of permanent tendon damage

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Treatments

Common treatments for tennis elbow:– Rehabilitation.– Use of a forearm brace.– Use of injections of cortisone.– Strengthening and stretching exercises.– Rest, ice and compression.

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Two Examples of Treatment

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Typical Rehabilitation Program

General stretching: active isolated stretching and dynamic movements.

Wrist flexion/extension: 3 sets of 10 using tubing.

Elbow flexion/extension: same as above.

Forearm Pronation/Supination: 3 sets of 10 with 5 pound weight.

Radial /Ulnar deviation: 3 sets of 10 with 3 pound weight.

Eccentric loading of wrist extensors: 1 set of 10 with 25 pound dumbbell.

Simulated tennis swings: forehand, backhand and serve. Using either a cable cross machine or a 3 pound weighted racket.

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Return to Play and Prevention

These two concepts really come combined with one another. As long as a person is scoring low enough on the pain scale from the earlier slides, usually from phases 0-3, they can come back or continue to be active. Also, if a player is just coming off of a rehab program and continues to use the exercises and or the brace for the forearm, they should be able to perform the necessary movements required by their sport of choice.

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References

• Signs and symptoms of athletic injuries. Gallaspy, James; Douglas may, J copyright 1996.

• Fundamentals of sports injury management. Anderson, Marcia; Hall, Susan copyright 1997.

• Tennis elbow. Buchbinder, Rachelle; Green, sally; Struijs, peter. American family physician. March 2007.

• Lateral Epicondylosis: A case study of conservative care utilizing ART and rehabilitation. Howitt, Scott. Journal of Canadian chiropractic association. 2006.

• Lateral Epicondylitis: review and current concepts. Faro, Frances; Moriatis wolf, Jennifer. Journal of hand surgery. Oct. 2007.