Tennis Elbow

Tennis elbow occurs with repetitive activities such as heavy lifting, vibration, or activities that involve gripping or bending the wrist backwards in excess of what the tendons current capacity. Therefore you often see it in jobs and sports such as electricians, carpenters, gardeners and those who play badminton, tennis or throwing activities.

If a person performs an activity in excess of what this muscle group is used to then the tendon undergoes a reactive adaptation where there is localised pain and potential swelling around the outer part of the elbow where these tendons attach. A few days of relative rest and pain relief will allow this tendon time to settle however if the tendon continues to be loaded then it will progress through the next two stages of tendon disrepair and then degenerative tendon where there are structural changes within the collagen matrix and the ingrowth of blood vessels into the tendon in an attempt to assist repair.

The most reported symptom is pain located on the outside of the elbow either on the bony part itself (the lateral epicondyle) or on the extensor muscles. Pain can radiate upwards along the upper arm and also downwards in and around the forearm. There may also be a weakness and / or pain when gripping items day to day little kettles etc.

An accurate diagnosis can be provided via thorough history taking and identifying the symptoms mentioned previously and:

• Pain over the outer park of the elbow and / or 1-2cm below
  
• Pain and weakness on resisted wrist extension
  
• Weak grip
  
• Pain and / or decreased movement on passive elbow extension and wrist flexion
  
• Pain when resisting extension of the middle finger

A thorough examination will also rule out other possible causes of your elbow pain, such as osteoarthritis or referral from the neck

• Education and advice
  
• Activity modification
  
• Manual therapy
  
• Therapeutic ultrasound
  
• Taping / Supports
  
• Progressive exercises start at Isometrics for the more symptomatic patients
  
• Return to sport discussion and planning