Tennis Elbow

Tennis Elbow

Acute Tennis Elbow is an injury to the muscles that extend the wrist and fingers. The site of injury is typically the lateral epicondyle, a bony bump on the outside of the elbow where these muscles attach.

Tennis Elbow symptoms that have lasted more than 6 weeks are considered to be sub-acute and beyond three months, as chronic tennis elbow.

What are Tennis Elbow Symptoms?

Typically the Tennis Elbow sufferer will experience pain when performing gripping tasks or resisted wrist/finger extension. Pain can also be present when the muscles are stretched. There will be tenderness directly over the bony epicondyle, and there may be trigger points in the wrist muscles.

Some sufferers will also have neck stiffness and tenderness, as well as signs of nerve irritation. Most elbow movements will be pain-free, despite that being the area of pain.

Common Tennis Elbow Causes include:

Unaccustomed hand use. eg painting a fence, hammering, lots of typing.

Excessive gripping or wringing activities

Poor forearm muscle strength or tight muscles

Poor technique (this may be a poor tennis shot)

In some cases such as Chronic Tennis Elbow, this can occur due to the soft tissues being in poor health, which are easily injured. Inflammation follows the injury, which leads to swelling and elbow pain.

What Causes Chronic Tennis Elbow?

Chronic Tennis Elbow is associated with degenerative changes in the muscle tissues located at the epicondyle. Although for a long time this was thought to be related to inflammation from overuse, this is now known to be incorrect.

Who Suffers Tennis Elbow?

Tennis Elbow occurs commonly in the community. It is present in 40% of all tennis players (hence its name) and 15% of people working in repetitive manual trades. It can occur at any age, however, sufferers are generally between the ages of 35 and 50.

Predictably, the side affected is usually associated with handedness, but it can occur in the non-dominant arm. Males and Females are affected equally.

Tennis Elbow Treatment

Physiotherapy has been shown to be effective in the short and long-term management of tennis elbow.

Physiotherapy aims to achieve a:

Reduction of elbow pain.

Facilitation of tissue repair.

Restoration of normal joint range of motion and function.

Restoration of normal muscle length, strength and movement patterns.

Normalisation of your upper limb neurodynamics.

Normalisation of cervical joint function.

There are many ways to achieve these and, following a thorough assessment of your elbow, arm and neck, your physiotherapist will discuss the best strategy for you to use based on your symptoms and your lifestyle. Results are typically measured through patient feedback and measurement of pain-free grip strength.

Physiotherapy treatment can include gentle mobilisation of your neck and elbow joints, electrotherapy, elbow kinesio taping, muscle stretches, neural mobilisations, massage and strengthening.

What is Your Tennis Elbow Prognosis?

Untreated Tennis Elbows can last anywhere from 6 months to 2 years. You are also prone to recurrence.

Studies have shown physiotherapy to be the most effective way of managing Tennis Elbow when compared to steroid injections or giving of advice alone. In a recent study,

When given a 6 week course of physiotherapy comprising of 8 treatment sessions, most patients show significant improvement after 3 weeks, increasing to a 60% or greater recovery after 6 weeks of treatment. This improvement is shown to continue to around a 90% improvement at 12 months, even without further treatment.

By comparison, provision of advice only resulted in a recovery of 60% or greater being delayed a further 6 weeks, to three months. Over longer periods of time, patients given good advice did recover, and by 6 months had achieved similar gains to the treatment groups. This was maintained over time and continued to improve.

Cortisone injections resulted in very good initial improvements with almost 80% reduction in symptoms after 3 to 6 weeks. BUT (and its a big one) patients who received cortisone injections showed an increase in pain after 6 weeks, and by 3 months had fallen well below both the physio treatment groups AND the advice only groups in terms of their recovery. This deterioration was followed by delayed healing, resulting in the cortisone injected group having almost 30% more pain after 12 months than if they had followed advice alone.

For this reason, researchers do not recommend cortisone injections as a stand alone treatment for Tennis Elbow.

Further research is currently been undertaken to assess the effectiveness of cortisone injections combined with physiotherapy management to see if the initial early gains can be better maintained.

For more advice about tennis elbow, please ask your physiotherapist.