Tennis Elbow

What is tennis elbow?

Tennis elbow is a syndrome, not a diagnosis, so it is best referred to as lateral elbow pain. Other labels for this condition include lateral epicondylitis, extensor tendonitis and common extensor tendinopathy. “Tennis elbow” refers to pain experienced on the outside of the elbow, as distinct from “Golfers’ elbow” which is felt on the inside of the elbow. Most people who experience tennis elbow don’t play tennis, but it does tend to occur in persons who use their hand repeatedly for gripping and reaching activities, often where there is an element of occupational repetition. Tennis elbow is one of the most recalcitrant problems seen in the clinic.

What causes tennis elbow?

There are many causes and sources for lateral elbow pain including referral from the cervical spine, elbow joint problems, nerve entrapment syndromes and muscle/tendon lesions of the forearm muscles. For example, the source may be the tendons of the common extensor origin (group of muscles on the outside of the elbow), whereas the cause may be faulty neck, back and arm posture that puts the arm in a biomechanically-disadvantaged position; made worse by an occupational overuse situation. A functional diagnosis is made when the source and cause are identified.

How do you treat tennis elbow?

Treatment of lateral elbow pain is a direct response to the diagnosis. Depending on the diagnosis, local treatment may include physiotherapy to the elbow joint to restore range of movement, or to the local muscle lesion, or to free-up the sliding of the nerves. Exercises may be required to stretch or strengthen muscles. Eccentric exercise is currently in vogue (see below). Some doctors inject the muscle with cortisone or macerate the muscle with a needle. The latter is to stimulate a bleeding and healing response. More global treatment approaches may require attention to the cervical spine to reduce referred pain, or correction of faulty neck, back and arm posture to reduce strain on the elbow region. Braces are sometimes useful, as is acupuncture. Surgery is rarely required, but may be indicated if there is fault inside the elbow joint, or a nerve entrapment, or severely damaged or ruptured common extensor muscle. Attention may need to be given to sporting or occupational technique where the arm is used repeatedly, eg. baseball pitcher, gymnast or bricklayer.

What is the role of eccentric exercise in treatment of tendinopathy?

Recent research into the classic extensor tendon variety of tennis elbow has demonstrated that it is not an inflammatory problem. Rather, under close analysis, the tendon appears to be degenerate from chronic strain and a failed or half-completed healing process. There appears to be collagen (tendon framework) break-down at a microscopic level. The treatment response to this is to challenge the tendon with a heavy but very specific exercise to stimulate new collagen growth to complete the healing process. This exercise programme needs prescription from a suitably trained physiotherapist along with monitoring of response.