TENNIS ELBOW
by Arthritis Research Campaign
Not just tennis
You may well be puzzled. Your doctor has told you that you've got a 'tennis
elbow', yet you might never have held a tennis racquet in your life!
The truth is the ailment is caused by a physical strain. Of course, a
strenuous game of tennis could be the cause, but it could be any one of a
number of activities. People who are continually gripping and twisting -
carpenters and dentists, for instance - are particularly prone to this painful
condition.
The medical name for tennis elbow is 'lateral epicondylitis'. The lateral
epicondyle (see diagram) is the bony part you can feel on the outside of your
elbow joint. It is outside the joint and so is unaffected by arthritis or
deformity, but it is often prominent, especially in thinner people, and
consequently it can easily be knocked, which causes soreness and bruising.
A similar condition to tennis elbow can occur on the 'medial (inside)
epicondyle' commonly known as the 'funny-bone'. This has been called golfer's
elbow, although, again, it is by no means confined to those who enjoy a round
of golf.
Other descriptive names have been given to painful elbows that afflict
occupational groups such as 'gaoler's elbow' - a condition that occurs from
opening and closing heavy cell doors. There is even a 'Cresta elbow', which can
afflict those who undertake the hazardous Cresta toboggan run in St Moritz,
though this is unlikely to be a problem to patients in this country!
Diagnosis
This condition can be readily diagnosed from clinical features. And it can
usually be treated by a GP without the need to go to hospital.
The symptoms
Tennis elbow is uncommon in anyone under 40 or over 60 years of age.
Different people experience varying degrees of pain ranging from a mild
discomfort when the arm is used, to an ache severe enough to prevent them
sleeping. The pain is made worse by gripping or twisting movements; the lateral
epicondyle will feel tender, something you will notice, particularly if you
catch your elbow.
Repeated movements of the wrist, especially those meeting resistance - such
as a backhand tennis stroke - will make matters worse.
The same might happen if you were using a paint roller on a ceiling. This is
because those tendons that enable you to stretch back your fingers and wrist
(known as the extensor tendons) all come together and are fixed into the
lateral epicondyle. Lifting heavy weights at work or at home can cause further
aggravation.
Tenderness in this bony area is a sign of tennis elbow
Also you may well notice some pain further down your forearm. You should not
experience any tingling in the arm or fingers, tingling here would indicate
some other condition, such as pressure on the nerve in the neck (cervical
spondylosis), or at the wrist (carpal tunnel syndrome).
There should be no swelling around the elbow joint itself though,
occasionally, the localised tender areas might display this sign. You may be
asked to go for X-rays or blood tests, but these are quite normal as it is not
a serious form of rheumatism.
The cause
Tennis elbow usually arises when the tendons coming from the muscle of the
forearm become inflamed at the point where they join the epicondyle. Although
it is painful, it is quite harmless; there are no long-term effects and it has
nothing to do with arthritis or any other disease.
Treatment
The condition is likely to get better by itself if you cut out excessive or
repetitive movement of the elbow. Sometimes just putting your arm in a sling
for a few days will do the trick.
Repeated movements of the wrist can aggravate the pain
Some people find warmth (from a hot water bottle, for example) helps. Others
find that a cold ice-pack (such as a packet of frozen peas wrapped in a towel)
- placed on the tender area twice a day for ten minutes - is beneficial. Mild
pain-killing tablets like soluble aspirin, obtained from the chemist will also
help.
If the pain shows no sign of abating, your doctor may suggest a cortisone
drug (steroid) injection into the tender area. There is no risk of the
side-effects some people suffer when steroids are taken by mouth, since the
drug is injected only into the affected area.
There is a slight possibility that the pain will actually become worse for
a few hours after the injection. Occasionally the pain may be severe and last
for up to 48 hours. A repeat injection may be necessary for persisting pain.
However 75 percent of patients recover after the first injection, though you
may still be advised to rest your elbow as much as possible for up to two or
three weeks afterwards.
If the pain should continue and become 'chronic' (lingering), physiotherapy
might help. Deep massage and friction combined with ultrasound may be
suggested. The ultrasound penetrates deep into the painful tissues and can ease
the discomfort. Occasionally, manipulation is advised in long-standing cases so
as to break down any fibrous adhesions that may have formed.
Various methods of strapping or splinting the forearm may be tried to
relieve the strain on it. In very rare cases the elbow has to be encased in
plaster to rest the area completely and allow the inflammation to settle.
Equally rarely, an orthopaedic surgeon might be asked to relieve the condition
by a minor tendon-releasing operation.
The end in sight
If you're suffering from tennis or golfer's elbow you will have to face the
fact that you may be in pain for some time - perhaps as long as a year or more.
But the good news is that the condition is what's known as 'self-limiting';
that means it will get better naturally.
The good news is that the condition will get better naturally
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