TENNIS ELBOW – QUESTION: A 28 year old male carpenter is suffering from acute pain when gripping his fingers, particularly when using hammers and screwdrivers at work. The bony outer part of his elbow is also tender and he is experiencing some stiffness in the neck.
What Is Tennis Elbow?
Tennis Elbow is an injury to the muscles that extend from the elbow to the wrist. Pain can occur in various places down the arm and in the neck, generally in the lateral epicondyle – the bony outer part of the elbow where muscles from the hand and wrist are attached.
There are different degrees of Tennis Elbow. Symptoms lasting more than 6 weeks are considered sub-acute, whereas those lasting more than three months are considered chronic. It is generally caused by an excess of stress on the muscle tissue at the anchor point where the arm bone meets the elbow.
As its name may indicate, Tennis Elbow is a stress injury caused by excessive force from strenuous activity. This may include:
• Excessive gripping activities (Tennis Elbow was first described in 1873 as “writer’s cramp” – named after the writers who suffered from the injury after excessive gripping of styluses).
• Incorrect hand use while hammering, painting, typing etc
• Poor muscle and tissue health meaning it can be easily injured
• Incorrect technique while throwing, or hitting (hence its namesake). Tennis players believe the condition comes from high repetition of movement – such as serving – which causes tiny tears to open up in the tissue.
Tennis Elbow symptoms generally come on quite slowly, the first being pain, dull aching or soreness in the outer part of the elbow after activity. This pain will be more acute when the area is touched, twisted or when gripping something (wrist movement). Pain may be even worse when sleeping and the elbow may be stiff in the morning. With acute cases of Tennis Elbow, even small actions such as picking up a cup or turning a key may be painful. Swelling is rarely a symptom. Some sufferers may also experience slight neck pain.
Minor cases of Tennis Elbow can be treated by simply resting the affected arm and desisting whatever the cause of the injury was. Icing the area after initial pain is felt can also help. The condition is will often get better over time, although this can take up to a year or more.
Most cases of Tennis Elbow can be treated successfully without requiring surgery. Orthotic devices may be prescribed by your hand therapy specialist which can help to improve function and reduce pain during use. Specific neural glides, joint mobilisations and strengthening exercises may also be helpful in alleviating symptoms and achieving return to function.
Anti-inflammatory medication has also been known to be prescribed, although studies have shown their benefits to be minimal.
Surgical treatment may be required in extreme cases. Your therapist can discuss with you and your GP and arrange a referral to a surgeon if required.