TENNIS ELBOW? PHYSICAL THERAPY CAN HELP

My elbow hurts!“I’ve noticed that my elbow’s been hurting for awhile, and then one morning I couldn’t even pick up my cup of coffee.” This is a typical statement heard in countless doctors’ and therapists’ offi ces across the country. Lateral epicondylitis (pain felt on the outside of the elbow) is the most common cause of elbow and forearm pain in adults, with an incidence rate of 1-3% in the general population. [1,2] The causes and exact onset date are often unknown. Commonly referred to as tennis elbow (although < 5% of reported cases are attributed to tennis playing [3]), lateral epicondylitis is described as an infl ammation or even degeneration of the wrist extensor tendons at their common attachment on the elbow. The usual culprit is the ECRB (extensor carpi radialis brevis) tendon which runs from its point of origin on the lateral epicondyle of the humerus to its insertion within the hand (base of the third metacarpal). [4]

What may cause it?Repetitive elbow motions, twisting/rotation forearm motions, forceful gripping, sustained postures, and especially combined movements of the wrist and elbow (such as lifting/pulling items with the palm facing downward and elbow extended) may all cause elbow pain. Awkward positioning, ergonomic and other occupational factors all have their role as well.

What can I do about it?Daily extensor stretching , changes in positioning/activities, job modifi cations, rest from exacerbating factors, and home modalities (such as heat before stretching or icing after activity) may all provide relief. [4] Additional rest of the involved structures can be obtained through bracing, such as a wrist splint, compressive elbow sleeve, or counterforce strap, although these are not long-term solutions. Additionally, proper strengthening of the wrist extensors and the entire upper extremity is necessary to fully treat the problem and prevent re-occurrences.

Okay, my elbow still hurts. Now what?If self-management fails, seek advice from an orthopedic doctor or therapist. An occupational or physical therapist will create a specifi c treatment approach based on levels of acuity (severity of symptoms, and chronic or acute onset) and will explore possible causes. An experienced therapist can offer several types of manual techniques, appropriate strengthening, and education to manage symptoms in the long term.

Amanda Edsell, OTR/L, CHTKORT Old Brownsboro Crossing9880 Angie’s Way, Suite 100Louisville, KY 40241Phone: 502-339-4700www.kort.com

1. Verhaar JA. Tennis elbow: anatomical, epidemiological and thera-peutic aspects. Int Orthop. 1994; 18:263-267.

2. Allander E. Prevalence, incidence, and remission rates of some com-mon rheumatic diseases or syndromes. Scand J Rheumatol. 1974; 3:145-153.

3. www.vasportsmedicine.com (Nirschl Orthopaedic Center/Virginia Sportsmedicine Institute)

4. Skirven, Osterman, Fedorczyk, Amadio. Rehabilitation of the Hand and Uppe Extremity, 6th Ed. Mosby, Inc. 2011; 31, 87, 1105.

References