Introduction
Tennis elbow or lateral epicondylitis can be defined as the inflammation or swelling of the tendons that are responsible for bending the wrist backward. The muscles are attached to the bones with rugged bands or cords of tissue known as tendons. The tendon extensor carpi radialis brevis is most commonly involved in cases of tennis elbow. The disease is usually diagnosed in men and women between 30 to 50 years with no gender predilection.
What Are the Components of the Elbow Joint?
The elbow joint comprises three long bones. The humerus, the longest bone of the upper extremities, and the two bones, radius and ulna, are present in the forearm region. The bony bumps present in the lower part of the humerus are known as epicondyles and have several muscle attachments. These are termed medial and lateral epicondyles, respectively. The prominence present at the elbow is the lateral epicondyle. Several muscles, ligaments, and tendons hold the elbow joint in place.
Lateral epicondylitis is the inflammation of the lateral epicondyle region or the elbow. This condition is colloquially known as the tennis elbow, which involves the forearm muscles and tendons. The tendons and muscles responsible for the extension of the wrist and fingers are highly prone to injuries. The forearm muscles are responsible for extending the wrist and fingers and are called extensors, which attach the muscles to bone. The tendon affected in the case of tennis elbow is called the extensor carpi radialis brevis.
What Are the Causes Behind the Tennis Elbow?
As the name implies, the tennis elbow is most often caused by the force of a tennis racket hitting balls while playing the backhand. The muscles of the forearm, by such repetitive strain, become sore. A backhand stroke while playing tennis causes the tendons that roll over the end of the elbow joint to be damaged. The underlying causes behind tennis elbow are as follows;
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Improper backhand strokes while playing tennis.
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Weakness in the shoulder muscles, wrist muscles, or both.
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Use a tightly strung or short tennis racket.
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Other sports involve the use of rackets.
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Hitting off-center on a racket.
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Incorrect grip.
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Hitting heavy or wet balls.
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Many people who suffer from tennis elbow are not tennis players.
Any repetitive movements can cause this problem. The other causes of tennis elbow are enlisted as follows;
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Painting using brushes or rollers.
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Operating chainsaws.
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Frequent use of hand tools regularly.
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Professionals that require repetitive strokes in their field of work, such as butchers, musicians, dental surgeons or assistants, and carpenters.
What Are the Signs and Symptoms Exhibited in the Case of Tennis Elbow Patients?
The most common symptoms of tennis elbow are enlisted as follows;
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A sensation of pain, burning, or aching along the outer border of the forearm and elbow may be felt.
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This pain may aggravate over time, and continuation of the causative activity even after symptoms are seen can lead the pain to radiate to the wrist, even while at rest, and may persist when placing the arm and hand in a palm-down position on a table or any other level surface and then trying to raise it against resistance applied.
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Pain may also be felt when lifting or gripping small objects, such as a pen or a teacup.
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A weak grip is another common manifestation of tennis elbow. The symptoms may also mimic other medical problems or conditions, and a specialist must be consulted for a proper diagnosis.
How Is a Tennis Elbow Diagnosis Confirmed?
Diagnosis of a tennis elbow can usually be made by a physical exam and a good medical history. Medical imaging techniques may also be used, as enumerated below;
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X-Rays: X-rays are done to check if arthritis is present in the elbow joint.
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Magnetic Resonance Imaging: MRI scans can show the damaged tendons and analyze the damage's severity. MRI scans of the neck can rule out arthritis or degenerative disk diseases in the spine, causing pain in the elbow, arm, or wrist.
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Electromyography: Electromyography or EMG is done to check the muscle physiology. However, this test is rarely done.
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Nerve Conduction Study: This is a test done to check the functioning and the ability of electrical conduction in sesnory and motor nerves. However, this test is done only if there are symptoms present that suggest nerve related issues.
How Is Tennis Elbow Treated?
The movements responsible for the injury in the first place are to be ceased with immediate effect. After that, the treatment approach can either be surgical or non-surgical, depending upon the extent of the damage and the response to treatments.
Non-surgical Treatments:
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Resting the affected arm.
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The immediate stoppage of the activity produced the symptoms in the first place.
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Application of ice packs to reduce inflammation of the affected site.
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Strengthening and stretching exercises as directed by a physical or occupational therapist.
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Prescribing anti-inflammatory medication such as Ibuprofen or Naproxen relieves the symptoms.
If the treatment mentioned above modalities do not work or the pain aggravates, the doctor may suggest the following:
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Bracing the affected area.
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Movement in the affected area should be limited to prevent symptoms from aggravating.
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Using special braces known as elbow braces while performing certain activities. Individuals have the option to purchase this kind of elbow brace for pain relief.
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Injecting steroids to help reduce pain and swelling in the affected area. However, this is to be used judiciously as it may have a role in prolonged symptoms.
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Ultrasound therapies can help break up scar tissue, increase blood flow, and promote healing.
Surgical Treatments:
If a patient does not respond to the non-surgical treatment modalities even after six months to a year, the doctor may recommend surgical treatments. Surgical procedures for tennis elbow mainly involve removing the diseased muscle fibers and reattaching healthy muscle tissue back to the bone. The right surgical approach depends upon a host of factors. The scope of the injury, the patient's general health status, and specific treatment needs must be addressed. A doctor must be consulted in this regard, and the results and risks associated with each procedure must be made known to the patient.
- Open Surgery: This is the most common approach to tennis elbow repair and involves making an incision over the elbow. It is an outpatient surgical procedure and rarely requires admission to the hospital.
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Arthroscopic Surgery: Treatment of tennis elbow can be done with minimally invasive surgical techniques using miniature instruments and small incisions guided by an arthroscope. It is also an outpatient procedure.
What Are the Postoperative Risks Following Surgery?
As with any surgical procedure, tennis elbow surgery may also give rise to certain complications, the most common of which include the following;
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Infection of the surgical site.
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Damage to nerves and blood vessels at the surgical site.
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A prolonged rehabilitation phase postoperatively.
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Loss of strength in the affected arm.
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Loss of flexibility of the affected arm.
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The necessity for future surgeries.
What Does Postoperative Rehabilitation Entail After Tennis Elbow Repair?
Following surgery, the affected arm may be immobilized for a while using splints. The sutures and splint are removed after a week to ten days post-surgery. After the splint is removed, exercise regimens are prescribed by a physical or occupational therapist to stretch, bend and flex the elbow to restore functionality. Gradual strengthening exercises are not prescribed until two months after surgery. Any athletic activity has to be deferred unless otherwise advised by the doctor, usually about four to six months following surgery.
How to Prevent Tennis Elbows From Occurring?
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Keeping the arms flexible and strong through regular exercises.
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Avoid repetitive movements or provide adequate rest to the area intermittently.
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Warm-up exercises before beginning the actual heavy exercise
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Warm-up exercises before playing sports or other repetitive activities are required professionally.
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Ensuring proper equipment while playing sports.
Conclusion:
Tennis elbow, a simpler term for lateral epicondylitis, is the inflammation of the tendons responsible for the backward bending of the wrist. The movements that resulted in the injury in the first place are to be ceased immediately. Depending upon the severity of the injury, symptoms, and response to the treatment, tennis elbow can be treated either surgically or non-surgically. Moreover, just like any surgical procedure, surgery for tennis elbow can also cause certain complications. Following surgery, the affected arm may be immobilized for some time using splints. After the removal of the sutures, certain exercises are advised by a physical or occupational therapist. The success rate of tennis elbow surgery is around 80 % to 90 % of patients, but it is common to see a loss of strength and flexibility.
