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Tennis elbow which is also known as lateral epicondylitis is a condition where there is an injury to a tendon in the elbow which causes pain and tenderness around the outside region of the elbow. Muscles and tendons in the forearm can become damaged from overuse, mainly in repetitive activities.
Any activity involving the muscle group that helps in straightening the arm can cause damage to the structures (muscles and tendons) in the forearm. It is common in carpenters and laborers and is similar to Golfer’s elbow which affects the inner part of the elbow. Tennis elbow is classified as an overuse injury, as it is usually present after repetitive trauma to the muscles in the forearm.
 

Symptoms

Symptoms of the tennis elbow injury can include:

  • Pain, which is enhanced by heavy lifting or simple tasks where lifting of objects above the elbow is required
  • Pain on the outer side of the elbow and tenderness (pain upon touching) on a prominent part of the bone on the outside of the elbow.

The pain also increases during gripping and movements of the wrist. There might also be the weakness of the forearm and inability to carry heavy items in the affected elbow.
 

Causes/Risk Factors

Risk factors are advancing age and people who perform repetitive activities (occupation and sports) and therefore increases stress on the tendons. The incidence of tennis elbow was found to be varying in different populations. A study found that there is 1-3% affected in the population with a peak incidence in the ages of 40s to 50s. 50% of competitive tennis players were found to be affected by at least one episode of this condition.
Increased playing time was also found to increase the risk of tennis elbow. It is believed that the repetitive nature of hitting tennis balls may have led to tiny tears in the forearm tendon at the elbow.
 

Diagnosis

Tennis elbow is considered as an overuse injury, usually presenting after unrecognized trauma to the muscles in the forearm. It is diagnosed clinically with patient history and examination of the elbow. X-rays and other types of imaging can also be used to include or exclude other conditions. It is generally a self-limiting condition but in some people, the symptoms may persist for 18 to 24 months and in some cases, even longer.
 

Treatment

The treatment aims to relieve pain, control inflammation, promote healing, improve local and general fitness, and also to control activity loads. Most patients will improve with conservative measures such as analgesics, rest, activity modification, physical therapy, and injections but a small percentage of patients will require surgery.
Steroidal injections have been found to be harmful in the long term and are no longer recommended in most cases. Other treatment such as ice packs, hot packs, bracing, and acupuncture were also found to be helpful. Left untreated, tennis elbow can result in long term pain that affects quality of life.
 

Prevention

It is important that patients should be counseled on how to cut down on activities that aggravate their condition and to do exercises that stretch and strengthen their arms.
Strengthening the forearm muscles also increases the stability of the elbow joint and plays a big role in preventing future recurrences of tennis elbow.
Competitive athletes can also be taught how to avoid recurrent episodes by decreasing the amount of playing time and using equipment appropriate to ability, body size, and muscular strength. It is vital that patients understand that continuation of activity after having tennis elbow may lead to mandatory rest and permanent pain that can only be treated by surgery.


 SOURCES

[1] Noteboom T, Cruver R, Keller J, Kellogg B, Nitz AJ. Tennis elbow: a review. Journal of Orthopaedic & Sports Physical Therapy. 1994; 19(6):357-366.

[2] Tosti R, Jennings J, Sewards M. Lateral epicondylitis of the elbow. The American journal of medicine. 2013, 126(4): 357.e1-357.e6.

[3] Allander E. Prevalence, incidence and remission rated of some common rheumatic diseases and syndromes. Scandinavian Journal of Rheumatology. 1974; 3:145-153.

[4] Maylack FH. Epidemiology of tennis, squash, and racquetball injuries. Clinical Sports Medicine. 1988; 7:233-243.

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