A Patient's Guide to Lateral Epicondylitis (Tennis Elbow)
Introduction
Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow--painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.
This guide will help you understand
- what parts of the elbow are affected
- the causes of tennis elbow
- ways to make the pain go away
Chiropractic Treatment
Chiropractic treatment is usually only needed for four to six weeks. Chiropractic manipulation can help restore the normal alignment and motion of the elbow joint. This is sometimes called closed reduction manipulation. This is where chiropractic manipulation has an advantage over other specialties. It is important to manipulate and stretch capsular joint restrictions during the treatment phase. Chiropractic care focuses on not just relieving the symptoms, but correcting the underlying problem. Before any treatment can begin, you will begin a standard chiropractic examination of the head, neck and upper back and entire upper extremity to check for any nervous system interference to the group of nerves called the brachial plexus. Research studies have shown that spinal manipulation/adjustments to the neck are effective in treating tennis elbow.
When symptoms are from tendonosis, you can expect healing to take longer, usually up to three months. If your tendonosis is severe, it may take at least six months for complete healing. If the problem is caused by acute inflammation, sometimes anti-inflammatory medications such as ibuprofen may give you some relief, but it will not correct the problem.
Dr. Zohn and Dr. Kane will give you tips on how to rest your elbow and how to do your activities without putting extra strain on your elbow. We may apply tape to take some of the load off the elbow muscles and tendons. You may need to wear an elbow strap that wraps around the upper forearm in a way that relieves the pressure on the tendon attachment.
Ice and electrical stimulation to ease pain and improve healing of the tendon. Deep muscle work is sometimes performed to help breakdown scar tissue and adhesions which form in the muscles and tendons. Treatment sessions may also include iontophoresis, which uses a mild electrical current to "push" anti-inflammatory medicine to the sore area. Exercises are used to gradually stretch and strengthen the forearm muscles. Because tendonosis is often linked to overuse, your chiropractor will work with you to reduce repeated strains on your elbow. When symptoms come from a particular sport or work activity, we will observe your style and motion with the activity. You may be given tips about how to perform the movement so the elbow is protected. We can check your sports equipment and work tools and suggest how to alter them to keep your elbow safe.
Anatomy
What parts of the elbow are affected?
Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendon. Tendons connect muscles to bone.
Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other.
Because the collagen strands in tendons are lined up, tendons have high tensile strength. This means they can withstand high forces that pull on both ends of the tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move.
When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things, hit a tennis ball in a backhand swing in tennis, or do other similar actions.
Causes
Why did I develop tennis elbow?
Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.
In an acute injury, the body undergoes an inflammatory response. Special inflammatory cells make their way to the injured tissues to help them heal. Conditions that involve inflammation are indicated by "-itis" on the end of the word. For example, inflammation in a tendon is called tendonitis. Inflammation around the lateral epicondyle is called lateral epicondylitis.
However, tennis elbow often does not involve inflammation. Rather, the problem is within the cells of the tendon. Doctors call this condition tendonosis. In tendonosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.
Instead of inflammatory cells, the body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.
No one really knows exactly what causes tendonosis. Some doctors think that the forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.
Symptoms
What does tennis elbow feel like?
The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers. The forearm muscles may also feel tight and sore.
The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won't straighten out completely.
Diagnosis
How can my doctor be sure I have tennis elbow?
Your doctor will first take a detailed medical history. You will need to answer questions about your pain, how your pain affects you, your regular activities, and past injuries to your elbow.
The physical exam is often most helpful in diagnosing tennis elbow. Your doctor may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow.
You may need to get X-rays of your elbow. The X-rays mostly help your doctor rule out other problems with the elbow joint. The X-ray may show if there are calcium deposits on the lateral epicondyle at the connection of the extensor tendon.
Tennis elbow symptoms are very similar to a condition called radial tunnel syndrome. This condition is caused by pressure on the radial nerve as it crosses the elbow. If your pain does not respond to treatments for tennis elbow, your doctor may suggest tests to rule out problems with the radial nerve.
When the diagnosis is not clear, your doctor may order other special tests. An MRI scan is a special imaging test that uses magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones.
Ultrasound tests use high-frequency sound waves to generate an image of the tissues below the skin. As the small ultrasound device is rubbed over the sore area, an image appears on a screen. This type of test can sometimes show problems with collagen degeneration.
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All materials from eORTHOPOD® are the sole property of Medical Multimedia Group, L.L.C.. and are used herein by permission. eORTHOPOD® is a registered trademark of Medical Multimedia Group, L.L.C..
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