What to do about tennis elbow
Tennis elbow is the common term for lateral epicondylitis, an inflammatory
condition of the tendon that connects the extensor muscles of the lower
arm to a bony prominence on the outside of the elbow called the lateral
epicondyle. The condition causes pain at the point where the tendon attaches
to the epicondyle. The pain may radiate to the forearm and wrist, and
in severe cases, grip strength may lessen. It can become difficult to
perform simple actions like lifting a cup, turning a key, or shaking
As many as half of all people who play racket sports have the condition,
but most people who have tennis elbow didn’t acquire it by playing
tennis, squash, or racquetball. It can result from any activity that
involves twisting or gripping motions in which the forearm muscles are
repeatedly contracted against resistance, such as pruning bushes or pulling
weeds, using a screwdriver, or playing a violin. Tennis elbow is an occupational
hazard for professional gardeners, dentists, and carpenters.
There are many treatments for tennis elbow but not much high-quality
evidence about their effectiveness.
What goes wrong in tennis elbow?
Chronic overuse stresses the extensor muscles, causing tiny tears in
the tendons (see “Anatomy of tennis elbow”) that result in
inflammation, tenderness, and pain.
Tendons are made up of parallel strands of collagen lined up in side-by-side
bundles. When strains and tears disrupt this arrangement, the body responds
by deploying fibroblasts and other substances to form scar tissue that
helps shore up the area. Repetitive injury prevents the scar tissue from
healing properly, so it remains weak and painful.
Anatomy of tennis elbow
Tennis elbow occurs when repetitive stress causes small tears
in the tendon that connects the extensor muscles — which
run between the wrist and elbow — to the lateral epicondyle.
Treatments abound, but what works?
Studies haven’t come to any firm conclusions about the management
of tennis elbow. Many treatments relieve the pain, but in most cases
only temporarily.. Sometimes the best approach is to simply give the
elbow a rest.
A trial published in the British Medical Journal (Nov. 4, 2006)
randomly assigned 128 patients with tennis elbow to receive six weeks
of physical therapy, two corticosteroid injections, or a “wait
and see” approach in which participants were told to modify their
daily activities and use heat, cold, pain-relieving drugs, and braces
as needed. At the end of the one-year follow-up, improvements in pain-free
grip strength and overall pain were roughly equivalent in the physical
therapy and “wait and see” groups, while the corticosteroid
group was worse off — possibly because the rapid early reduction
of pain led to increased activity and overuse.
Australian researchers examined 28 randomized clinical trials involving
various nonsurgical interventions, including physical therapy, bandaging,
steroid injections, ultrasound, and acupuncture. They found that the
studies were either too brief or too poorly designed to shed any light
on long-term outcomes — or even to support the short-term use of
most treatments. What to do?
Here are some strategies that may help you prevent further injury to
the tendon, relieve pain and inflammation, and preserve or restore function.
Initial treatment. Cut back on movements and
activities that cause pain in the affected elbow, forearm, and wrist.
For additional pain relief, apply ice to the epicondyle for 15 to 20
minutes every four to six hours for the first day or so. Oral over-the-counter
pain relievers (ibuprofen, naproxen, aspirin, and acetaminophen) may
also help, but because of the risk of side effects, don’t take
them for more than four weeks. Some people find that it helps to wear
an orthotic (a brace, band, splint, or strap) around the forearm.
Intermediate steps. If symptoms persist, your
clinician may recommend a corticosteroid injection. This often provides
immediate relief, but don’t take that as a go-ahead to return to
activities that aggravate tennis elbow. After the injection, you’ll
be given a program to follow that includes rest, ice, and acetaminophen,
followed by physical therapy. Repeated injections can cause tissue atrophy,
so clinicians usually recommend no more than two to four, even in cases
of chronic pain.
Other measures. Surgery is an option in rare
cases when the symptoms have lasted more than a year despite rest and
other efforts to relieve pain and restore function.
May 2007 update
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