Health Care and Tennis Elbow

Ever hear anyone complain about tennis elbow, or perhaps feel you are suffering from it yourself? Is it because you are guilty of just playing too much tennis, or is the root cause something else?  Tennis elbow is a common term for a condition caused by overuse of arm, forearm, and hand muscles that results in pain in your elbow. You don't have to play tennis to get this, but the phrase developed because it can be a significant problem for some tennis players.

According to the American Academy of Orthopaedic Surgeons (AAOS), tennis elbow, or lateral epicondylitis, is a painful condition of the elbow. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk. Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow.

The forearm muscles and tendons become damaged from overuse � repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow. There are many treatment options for tennis elbow. In most cases, treatment involves a team approach. Primary doctors, physical therapists, and, in some cases, surgeons work together to provide the most effective care, according to the AAOS.

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms. Common signs and symptoms of tennis elbow include:

�         Pain or burning on the outer part of your elbow

�         Weak grip strength

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected, according to the AAOS. Much more info can be found at their website: http://orthoinfo.aaos.org/topic.cfm?topic=a00068.

According to the American Society for Surgery of the Hand (ASSH), pain is the primary reason for patients to seek medical evaluation. The pain is located over the outside aspect of the elbow, over the bone region known as the lateral epicondyle. This area becomes tender to touch. Pain is also produced by any activity which places stress on the tendon, such as gripping or lifting. With activity, the pain usually starts at the elbow and may travel down the forearm to the hand. Occasionally, any motion of the elbow can be painful. Here are some non-surgical ways to help improve the condition:

Activity modification � Initially, the activity causing the condition should be limited. Limiting the aggravating activity, not total rest, is recommended. Modifying grips or techniques, such as use of a different size racket and/or use of 2-handed backhands in tennis, may relieve
the problem.

Medication �anti-inflammatory medications may help alleviate the pain.

Brace �a tennis elbow brace, a band worn over the muscle of the forearm, just below the elbow, can reduce the tension on the tendon and allow it to heal.

Physical Therapy -may be helpful, providing stretching and/or strengthening exercises. Modalities such as ultrasound or heat treatments may be helpful.

Steroid injections �A steroid is a strong anti-inflammatory medication that can be injected into the area. No more than (3) injections should be given.

Shockwave treatment � A new type of treatment, available in the office setting, has shown some success in 50�60% of patients. This is a shock wave delivered to the affected area around the elbow, which can be used as a last resort prior to the consideration of surgery.

Surgery is only considered when the pain is incapacitating and has not responded to conservative care, and symptoms have lasted more than six months. Surgery involves removing the diseased, degenerated tendon tissue, according to ASSH. Procedures are typically performed in the outpatient setting. More info about tennis elbow can be found at this site: http://www.assh.org/Public/HandConditions/Pages/TennisElbow.aspx.

According to the National Institutes for Health (NIH), if your tennis elbow is due to sports activity, you may want to:

• Ask about any changes you can make in your technique.
• Check any sports equipment you are using to see if any changes may help. If you play tennis, changing your grip size of the racket may help.
• Think about how often you have been playing and whether you should cut back.

If your symptoms are related to working on a computer, ask your manager about making changes to your work station or have someone look at how you chair, desk, and computer are set up. An occupational therapist can show you exercises to stretch and strengthen the muscles of your forearm. More info can be found here: http://www.nlm.nih.gov/medlineplus/ency/article/000449.htm.

According to SportsInjuryClinic.net, stretching exercises for tennis elbow should begin as soon as pain allows. They should be performed very gently at first and continue throughout the rehabilitation process and after. Hold stretches initially for 10 - 15 seconds - during the acute stage. Later stretches can be held for up to 40 seconds. Repeat stretches 3 times and aim to stretch at least 3 times a day. Tennis elbow strengthening exercises should also begin as soon as pain allows. Again this will depend on how bad the injury is and is likely to be a few days after stretching exercises commence.

The basic rule is if it hurts doing the exercise then wait! Start with static exercises and gradually progress. When these can be done comfortably move onto concentric and then eventually eccentric type exercises. It is important that strengthening exercises are done before trying to return to activity. Also apply cold therapy after strengthening exercises to control pain and inflammation. Returning to regular activities should be done gradually whether the injury is work related or sport related. Only go back to normal activities when the elbow is pain free and strengthening exercises have been progressed. Much more information can be found at this site:  http://www.sportsinjuryclinic.net/sport-injuries/elbow-pain/tennis-elbow/rehabilitation-of-tennis-elbow.

Tennis elbow can be a serious injury if left untreated, and it can cause long term damage if you don�t take care of getting an early diagnosis and subsequent treatment. If you feel you may be experiencing pain due to overuse or continuous types of similar movements, see your doctor. Your physician should be able to diagnose your issue and recommend how you should take care of the problem. More serious cases should be referred to an orthopedic specialist for possible surgery or other options.

Until next time.