Lateral epicondylalgia, also known as Tennis Elbow, is a common disorder that effects the wrist extensor muscles in the forearm which originate from the elbow. In the past, this syndrome has been previously referred to as epicondylitis or tendinitis but these terms have now been phased out due to the misleading suggestion that the condition is caused by an inflammatory process. This is not the case and it is now understood that lateral epicondylalgia is a degenerative disorder of the extensor tendons in the forearm. This chronic condition is usually acquired through recreational, occupational or habitual activities whereby the single use of the upper extremity is more prevalent. Sporting examples may include tennis, squash, baseball or swimming and occupations with a high injury frequency being electricians, gardeners or carpenters.
The primary cause for lateral epicondylalgia is due to repetitive movements or contractile overloading which leads to chronic stress and micro trauma of the tendons. This micro tearing of the tendon causes a poor healing phase which compromises the structural integrity of the tendon and increasingly induces degenerative changes. Movements that involve constant rotation of the forearm, forceful gripping, repetitive vibrations or heavy lifting will progress the injury.
Symptoms can vary from person to person and some individuals may experience differing levels of severity, irritability and longevity of pain.
Symptoms normally include:
- Pain to the outside of the elbow over the lateral epicondyle and into the forearm.
- Weakness with grip strength and wrist extension
- Occasional burning sensation into the forearm.
- Sharper elbow pain on completing wrist extension or with any aggravating activities.
For the majority of people with lateral epicondylalgia, conservative management is advised and has been shown to be successful in the resolution of symptoms. This condition can take time to settle but on average patients see an improvement within 6-8 weeks. This may not always be the case and some people may have symptoms for up to 1-2 years from the initial onset.
Conservative treatments include:
- Activity modification – Advice is given on modifying or reducing aggravating factors to help relieve symptoms. This may be through lifestyle changes or training limits.
- Exercise – Through repeated studies, a progressive loading exercise programme to strengthen and lengthen muscles has been shown to improve pain and function in individuals.
- Taping/orthotics – It has been suggested that taping or bracing the elbow can help to provide pain relief in the early stages.
- Manual therapy – manipulation and mobilisation techniques have been shown to be effective in the management and treatment of symptoms.
With patients that are experiencing high levels of pain/discomfort, a corticosteroid injection can be used to settle pain and symptoms down quickly. The injections are effective for 3 months therefore it is important to continue with the other modalities of treatment. If conservative management fails, which is usually after 6 months of treatment with no improvement at all, surgical treatment may be indicated. This is only the case with 10% of the population that suffer with lateral epicondylalgia.
Elbow pain can be complex and may not originate from the elbow at all. It is therefore important that if you experience persistent elbow pain you seek medical advice. A doctor or physiotherapist can assess, diagnose and advise you on the best treatment and help you get back to what you love doing!