It is normally sore and painful on the outer part of your elbow, which is where the tendon inserts into the bone. Occasionally pain is felt on the inner side of the elbow. This is called golfers elbow and is due to a similar inflammation, but this time it is the tendon which bends your wrist and hand forward rather than backwards. Both of these conditions are caused by repetitive movements or sustained gripping.
Treatments
There are various ways of dealing with tennis elbow. The most common are outlined below.
- Anti inflammatory tablets e.g nurofen, cuprofen, voltarol, sergam
- Cortisone injection
- Physiotherapy. This includes manipulation, deep massage, some electrotherapy and as the elbow improves a graduated exercise regime. A specific type of strapping may also be used.
- A tennis elbow band or to give it the “proper” name…….epicondylitis clasp!!!
- Surgery. Generally the last resort, but can be very successful in those where conservative treatment has failed.
General advice
As this condition is essentially one of overuse, its rather obvious that to try to rest it as much as possible, particularly in the acute, extremely painful stage is a good idea!! It is not true about the no pain no gain scenario.
Tendons have a poor blood supply, so heal slowly.
It is easier to be successful in treatment if this condition is not allowed to become chronic i.e long standing. . When that does happen not only is there the simultaneous build up at the elbow of inflammatory and scar tissue, but the forearm muscles become progressively weaker putting yet more tension on the tendon.
Many people who have this condition have never played tennis at all. It is more likely to have been provoked by such activities as:- hammering, sweeping, hedge cutting, lifting heavy pans, using secateurs, polishing, in fact anything that combines sustaining a grip whilst simultaneously exerting a force. Activities that involve twisting e.g turning a key in a lock, undoing a bottle top, can also be painful in a significant number of people as the muscle involved also uses the same tendon at the elbow joint. It is consequently more common in the dominant arm, making it more difficult to rest it, as few of us are effortlessly ambidextrous!!
Management strategies
- One IMPORTANT strategy to adopt, however, is whenever one picks up a kettle or other heavy object, make sure the palm of your hand faces upwards NOT towards the floor. By doing this you use a completely different set of muscles rendering the activity pain free.
- If you have to use a tool that requires constant gripping eg shears, pad the handle out to make it slightly larger. Tennis and other raquet sport players should also adopt this strategy. Badminton and squash have a higher incidence of tennis elbow because of the “whippy” action required of the wrist. Similarly tennis players who suffer from this complaint should examine their technique, as the wrist ought to be locked in tennis and this may be contributing to the problem.
- Recent research has shown the benefit in these cases of embarking on a regime of graduated exercise. These can be shown to you by a physiotherapist for you then to continue at home.
- Specific strapping can also be used to take the strain away from the tendon. This is often used when the condition is acute and again later when going back to sport or chopping logs etc. as an additional insurance policy!!!!Your physiotherapist will show you how to do this or you may be advised to wear an elbow band for certain activities.
- Before returning to sport/activity one should be able, with the palm of the hand facing the ground, lift the hand and wrist fully back against a modest resistance without undo discomfort.