Athletic Injuries 101: Tennis Elbow

Dr. Sarah Ytsma explains common Athletic Injuries each month, this time, taking a look at “tennis elbow.”

Definition: Tennis elbow or “Lateral Epicondylitis” is a pain in the muscles surrounding the outermost side of the elbow and forearm due to strain, degeneration, tendon inflammation, or periosteal inflammation (inflammation of the outermost layer of the bone)at the muscle-bone junction. It occurs on the extensor side of the forearm. It accounts for 90% of  “tendinitis” at the elbow

Pathophysiology: Tennis elbow develops due to inflammation at the muscular origin of the extensor carpi radialis brevis muscle and the associated “Common Extensor Muscles”, causing microtears of the tendon with occasional fibrosis (or hardening) and tissue failure.

Risk Factors: Tennis elbow is very commonly seen in the following situations:

1. Tennis & racquet sport players –> usually associated with repetitive back hand swings
2. Carpenters, painters,  plumbers, bowlers, chiropractors, massage therapists, and occupations that require a lot of computer work.
3. Often can be associated with rotator cuff injuries as a secondary problem.

Common Predisposing Activities:

1.  General overuse of the forearm in:

• Repetitive wrist flexion/extension (tennis, badminton, racket ball, hammer)
• Repetition in the motion of using a screw driver
• Repetitive finger flexion & extension (i.e. typing) or wrist deviation (grocery scanning)

History , Signs & Symptoms: A gradual onset of intermittent pain in the elbow ( morning stiffness or stiffness/pain after rest); often involved in the activities listed above; often described with pain and weakness with grasping objects (lifting a book or coffee cup, turning a door knob, etc).

Physical Exam:

1.  Local tenderness around the lateral epicondyle & tendon attachment on the outside of the forearm.
2. No visible swelling is present typically
3. Pain with passive range of motion (when the doctor moves it), pain at end range of motion during wrist flexion/bending, and resisted range of motion testing.
4. Pain with gripping and grasping objects.
5. Trigger points found within the common extensor muscles
6. Orthopedic testing may be positive if done by a practitioner.

Management: This can be slow to respond to treatment. Treatments do not need to be aggressive to be beneficial.

1. Rest – rest until pain begins to subside.  Avoid aggravating and repetitive activities when possible for 2-3 weeks
2. Ice – apply a cold compress for 15-20 minutes or do an ice massage directly over affected muscles.
3. Compress – tape or a splint may help.
4. Joint mobilization of the wrist, elbow, shoulder and spine.
5. Massage therapy/soft tissue therapy as tolerated.
6. Electrotherapy: ultrasound, IFC, T.E.N.S.
7. Acupuncture treatments
8. Home exercises – stretches, strengthening (after the acute stage is through).
9. Alternating activities – desk ergonomics may need to be changed, changing work or athletic equipment and looking at athletic form should all help tennis elbow.

Dr. Sarah Ytsma provides traditional chiropractic care, soft tissue manipulation/mobilation, and clinical acupuncture treatments at her office locations in Chatham (463 St. Clair Street @ Activaid – 519.358.7342) and Blenheim (110 Talbot Street @ McLauchlin Wellness – 519.676.3311 ext.1). Dr. Ytsma believes in stabilization and rehabilitation of injured joints to get you functioning and back on your feet, or in the game. For more visit http://www.drsarahytsma.ca/