What Is Lateral Epicondylitis?
Lateral epicondylitis, also commonly called tennis elbow, is characterized by pain and inflammation on the outer part of the elbow. Despite its name, it is not limited to tennis players and can affect anyone who repeatedly performs activities that strain the tendons in the forearm. The main cause of lateral epicondylitis is repetitive motion or the overuse of the forearm muscles, particularly those involved in gripping, twisting, or lifting. Activities such as playing tennis, golfing, painting, typing, or using hand tools can contribute to the development of tennis elbow.
What Are the Symptoms of Lateral Epicondylitis?
The symptoms of lateral epicondylitis, or tennis elbow, include:
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Pain: The primary symptom is pain on the outer part of the elbow. The pain may gradually worsen over time and ranges from mild to severe and debilitating pain.
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Pain with Activities: Pain is often exacerbated by activities that involve gripping, lifting, or twisting motions of the wrist or forearm. Common activities that can trigger or worsen symptoms include shaking hands, turning a doorknob, using tools, playing certain sports (like tennis or golf), or typing on a keyboard.
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Radiating Pain: In some cases, the pain may radiate from the outer part of the elbow down the forearm, potentially reaching the wrist.
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Swelling: Inflammation can cause mild swelling over the affected area.
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Tenderness: The area around the lateral epicondyle (the bony bump on the outer part of the elbow) may be tender to the touch. Pressing on this area or certain movements of the wrist can elicit pain.
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Stiffness: Stiffness in the elbow joint is another possible symptom. It may feel difficult or uncomfortable to fully straighten or bend the arm.
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Weakness: Some individuals may experience weakness in the affected arm, particularly when gripping objects or performing activities that require wrist extension or lifting.
These symptoms may vary in intensity and duration from person to person. If an individual is suspected of having lateral epicondylitis or is experiencing persistent elbow pain, they must consult a healthcare professional for an accurate diagnosis.
How Is the Diagnosis of Lateral Epicondylitis Done?
The diagnosis of lateral epicondylitis is typically based on the combination of medical history, physical examination, and, in some cases, even imaging tests:
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Medical History: The healthcare provider will begin asking about the symptoms, including the location, duration, and severity of pain, along with the details of any activities that exacerbate or alleviate the symptoms. They will also inquire about the occupation, hobbies, and sports activities to determine if repetitive motions or overuse may be contributing factors.
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Physical Examination: The healthcare professional will perform a physical examination of the elbow, forearm, and wrist. They will look for signs of tenderness, swelling, or inflammation around the lateral epicondyle. They may also assess the range of motion, strength, and stability of the elbow joint. Specific tests, such as Cozen's test (wrist extension test) or Mill's test, may be performed to reproduce the pain and assess the condition of the tendons.
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Imaging Tests: In most cases, imaging tests are unnecessary for diagnosing lateral epicondylitis. However, in situations where the diagnosis is unclear or if there are other suspected conditions, imaging tests like X-rays or MRI (magnetic resonance imaging) scans may be ordered. These tests can help rule out other possible causes of elbow pain, such as fractures, arthritis, or ligament tears.
What Is the Traditional Physiotherapy and Shock Wave Therapy Treatment for Lateral Epicondylitis?
Traditional physiotherapy and shock wave therapy are two commonly used treatment approaches for lateral epicondylitis.
Traditional Physiotherapy- Traditional physiotherapy is often the first-line treatment for lateral epicondylitis. It is generally effective in reducing pain and improving function. The duration and frequency will vary depending on the severity of symptoms and individual response to therapy. Traditional physiotherapy is a conservative treatment approach that aims to reduce pain, promote healing, and restore function through various interventions. This typically includes:
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Manual Therapy: The physiotherapist may use hands-on techniques to mobilize and manipulate the affected muscles, tendons, and joints. This helps in reducing pain, improves range of motion, and promotes healing.
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Therapeutic Exercises: Specific exercises are prescribed to stretch and strengthen the forearm muscles and tendons. These exercises focus on gradually increasing the load and resistance to promote tissue adaptation and recovery.
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Modalities: Various modalities such as ice or heat therapy, ultrasound, electrical stimulation, or laser therapy may be used to alleviate pain, reduce inflammation, and enhance tissue healing.
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Ergonomic and Activity Modification: Educating the individual about proper technique is an essential component of physiotherapy. The physiotherapist can provide guidance on modifying activities and using proper ergonomic techniques to reduce strain on the affected area; this helps individuals understand how to avoid aggravating movements and prevent further injury.
Benefits of Traditional Physiotherapy:
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This treatment can help in addressing muscle imbalances, flexibility issues, and biomechanical factors contributing to lateral epicondylitis.
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Provides education and self-management strategies for long-term recovery.
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Personalized treatment approach tailored to individual needs.
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This approach can be combined with other treatment modalities for a comprehensive approach.
Shock Wave Therapy:
Shock wave therapy involves delivering high-energy sound waves to the affected area to stimulate healing and reduce pain. It can be performed using two different methods:
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Radial Shock Wave Therapy (RSWT): RSWT uses low-energy shock waves that are applied externally to the skin. It is non-invasive and typically requires multiple sessions. The shock waves promote tissue regeneration, improve blood circulation, and reduce inflammation.
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Extracorporeal Shock Wave Therapy (ESWT): ESWT uses high-energy shock waves that are focused on the affected area. It can be performed either extracorporeally (outside the body) or intracorporeally (inside the body, through a minimally invasive procedure). ESWT aims to break down scar tissue, stimulate healing, and reduce pain.
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Focused Shock Wave Therapy (FSWT): FSWT utilizes higher-intensity shock waves focused on the precise area of tendon degeneration. It is often administered under local anesthesia and is typically a single treatment.
Benefits of Shock Wave Therapy:
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It may help reduce pain and inflammation.
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Generally well-tolerated with minimal side effects.
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Non-surgical and non-invasive treatment options.
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It can stimulate tissue healing and regeneration.
Conclusion
Both shock wave therapy and traditional physiotherapy have shown positive results in the treatment of lateral epicondylitis. The choice between these approaches often depends on factors such as the severity of symptoms, patient preferences, and the healthcare professional's recommendation.
