Tennis Elbow

It is a common cause of elbow pain. It is a common cause of pain on the outer aspect of the elbow. It is seen mainly in patients between 30 and 50 years of age. Most commonly it affects individuals (male and female ratio almost equal) whose work profile involves repetitive wrist extension against resistance and repeated supination and pronation activities (twisting activities). It may be seen in tennis players (those using the back hand stroke) or at times even in nonplayers as those involved in activities like hammering, squeezing clothes, carrying loads like a bucket or suitcase in hand, etc.

Presentation: Patients present with small area of chronic pain on the lateral aspect of the elbow. Other characteristic symptoms are pain on wrist extension, pain when shaking hands, and frequently a weakened grip. Even lifting a cup of coffee can precipitate pain. Repeated use of the hand will maintain and often increase the discomfort.The pain usually gets worse for several weeks and even months; it may even radiate down the forearm.

X-ray

X-ray is usually normal.

Frequently Asked Questions:

Management

Initially management is conservative (pain killers and activity modification, exercises). Exercises are key to successful treatment.

AVOID THOSE MOVEMENTS/ACTIVITIES OF WRIT WHICH CAUSE PAIN IN THE ELBOW.

A wrist strap may be given to provide local support and restrict activities. Local heat therapies and intralesional steroid injections are useful in resistant cases. Some other treatment options involve injecting blood at the site to cause fibrosis or injecting platelet rich plasma (PRP) to provide growth factors and promote healing of lesions. Only in recalcitrant cases, surgery is needed where the origin of ECRB is debrided and if needed, released.

Exercises which are most effective for tennis elbow:

Eccentric exercises:

1. Start with a .5 to 1 kg weight (dumbbell or free weight).
2. Sit on a chair next to a table.
3. Exercises are done first with elbow bent to 90 degrees and then with the elbow straight. The palm should face the floor both the times. First bend the elbow to 90º and slowly lower the weight, then slowly raise it toward the ceiling. Hold for a few seconds every time you raise or lower down maximally. Repeat it 10 times. Take rest for 2 minutes. Now repeat the exercise with elbow straight again with palm facing the floor. Slowly lower and raise the weight 10 times, as described above.
4. When it becomes easy for you to do these exercises easily increase the weight by .5 or 1 kg to a maximum of 2 kg.
5. Do these exercises two times a day,5 days a week for three months.

Forearm Extensor Stretches:

Elbow straight, the palm facing the floor, stretch like shown in figure with other hand, hold for 30 seconds. Repeat it three times with 10 Sec interval in between two stretches.

Pronation-supination exercises:

As shown in picture below rotate your forearm so that your knuckles face to roof and ground alternatively. This is done with a weight (like ½ kg dumbbell) in the fist.

Perform 20 repetitions and do it two times a day.