Tim has submitted a very useful summary on tennis elbow, including short videos on assessment and early rehabilitation exercises. Feel free to leave any comments or questions you may have on the topic.
Tennis elbow or lateral epicondylalgia is a very painful and debilitating condition. As many would know, it occurs commonly throughout the population and even to those who don’t play tennis. The effects can mean severe disruption to work and recreational activities. A third of people with tennis elbow will have the pain for longer than a year. Meaning the right treatment approach is crucial to helping those with elbow pain enjoy their normal activities.
Lateral epicondylalgia will commonly present as lateral elbow pain that occurs gradually over time following repetitive use of the wrist extensors. Common activities that may lead to lateral elbow pain include gripping, using a screwdriver and playing tennis.
Assessment should include a review of elbow and wrist range of movement. Reproduction of the patient’s pain on one of three tests may indicate lateral epicondylalgia. These tests are;
- Palpation of the lateral epicondyle
- Resisted wrist, index finger or middle finger extension
- Gripping (grip strength can be quantified with a grip strength dynamometer)
It is also important to rule out other causes of the patient’s lateral elbow pain. Pain or restriction of movement at the cervical spine may indicate referred elbow pain. Other causes of lateral elbow pain include local arthritis, intra-articular pathology, nerve entrapment and posterolateral rotatory instability.
Factors that may lead to persistent lateral elbow pain are;
- Significance of tendon pathology
- High level of pain and disability
- Central sensitisation
- Neck and Shoulder pain
- Neuromuscular impairments
- Work related and psychosocial factors
Best practice treatment for lateral epicondylalgia has been identified as exercise with the addition of manual therapy. Corticosteroid injection has been found to give good short term relief. However, they have been seen to give worse outcomes after 6 to 12 months. Other injection therapies (platelet rich plasma/autologus blood injection/prolotherapy) show limited effectiveness. Therefore, injections are not seen as a first line treatment. The use of NSAIDs has been seen to give good effect from a pain relieving perspective to allow an active exercise program to continue. Physiotherapy management in the form of combined exercise and manual therapy has been shown to give slightly superior results to the wait and see approach. Physiotherapy should always be utilised when any of the factors related to persistent lateral elbow pain, outlined in the assessment, are present.
For more detailed information and useful references please visit http://www.southcarephysiotherapy.com.au/blogs/2016/12/12/its-not-always-about-tennis
We would like to thank Tim Barnwell for taking the time to put together this very useful summary article. Users are welcome to leave comments below.