Tennis elbow or lateral epicondylitis results from overloaded tendons. Anyone can get tennis elbow. Read about tennis elbow treatment at Meri Sehat.

Tennis Elbow (Lateral Epicondylitis)

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Iqra Mazhar

Overview

Tennis elbow is also known as lateral epicondylitis. It is a painful condition that results from over-stressed tendons usually caused by repetitive wrist and arm motions. Thus, causing inflammation, degeneration, and potential tearing. Tendons are bands of firm tissue that connect muscles to the bone.

The discomfort is on the elbow&#39;s lateral side, but it can spread down the back of your forearm. When you straighten or fully extend your arm, you will most likely experience pain. Tennis elbow can affect anyone, not just athletes. 
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Tennis elbow mainly results from the constant stress induced by activities, including loaded and repetitive gripping and wrist extension.

It affects 1-3% of the population and mostly happens between the ages of 30 and 50 years. However, it is more common in individuals over the age of 40<a href="#accordion">[1]</a>. The condition affects both men and women equally. In the United States, the annual incidence ranges from 1-3%<a href="#accordion">[2]</a>. 
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Signs and Symptoms

The signs and symptoms of tennis elbow appear gradually. In most occurrences, the pain is minimal at first and progressively worsens over weeks and months. Typically, there is no specific injury associated with the onset of symptoms.

Tennis elbow symptoms may resemble those of other medical problems or conditions. Always seek guidance from your doctor for a diagnosis. 
&nbsp;

The signs are given below:

<ul>
	<li>Pain Or Burning on the outside of the elbow, which may spread to your wrist (these sensations may worsen at night).</li>
	<li>Elbow Pain that is initially mild, but gradually worsens.</li>
	<li>Arm Pain when twisting or bending (for example, turning a doorknob or opening a box).</li>
	<li>Firmness Or Discomfort when extending your arm.</li>
	<li>Swollen Elbow Joint that is sensitive to the touch.</li>
	<li>Weakened Grip when attempting to hold items such as a racquet, wrench, pen, or someone&#39;s hand.</li>
	<li>Occasionally, pain at night. 
	&nbsp;</li>
</ul>

Forearm activity, such as holding a racquet, turning a doorknob, or shaking hands, may frequently aggravate the symptoms. The dominant arm is most commonly affected, but both arms can be affected. 
&nbsp;

Causes

A variety of factors can cause tennis elbow. It is typically caused by overuse of the forearm due to repetitive or strenuous activity. As the name implies, playing tennis, specifically the constant use of the backhand stroke with bad technique, is one potential cause of this condition.

Occasionally, it can also happen after hitting or knocking your elbow. If the muscles in your forearm are sprained, small cracks and swelling can form near the bony lump (lateral epicondyle) on the outside of your elbow. Frequent use of the forearm muscles can also cause a tennis elbow. Moreover, it can result from a sudden arm or elbow injury. And, in rare cases, people may develop the condition for no apparent reason (idiopathic tennis elbow). 
&nbsp;

<h5>Activities</h5>

Tennis elbow can develop from any activity that includes constantly twisting your wrist and bending your elbow, or using your forearm muscles. 
&nbsp;

Here are some examples:

<ul>
	<li>Playing racquet sports (tennis, badminton, or squash) or throwing sports (javelin or discus).</li>
	<li>Constantly employing hand tools (gardening shears, screwdrivers or scissors).</li>
	<li>Using tools while decorating, plumbing, or laying bricks</li>
	<li>Activities requiring fine, repeated hand and wrist movements (typing or sewing).</li>
	<li>Activities involving repeated elbow flexion (playing the violin). 
	&nbsp;</li>
</ul>

Diagnosis

Many factors will be considered by your doctor when making a diagnosis. These include the onset of your symptoms, occupational risk factors, and participation in recreational sports. Your doctor will discuss with you what activities cause symptoms and where the symptoms occur on your arm. If you have ever injured your elbow, or have a history of rheumatoid arthritis or nerve disease make sure to inform your doctor.

Your doctor will use many tests to determine the diagnosis. Often, your medical history and physical exam are sufficient for the doctor to diagnose tennis elbow. However, if your doctor suspects another medical condition, they may recommend X-rays or other imaging tests.The following tests may help diagnose tennis elbow: 
&nbsp;

<ul>
	<li>
	<h5>Physical Exam</h5>
	</li>
</ul>

Your medical professional may apply stress to the affected region, and ask you to move your elbow, wrist, and fingers in different directions during the physical exam. 
&nbsp;

<ul>
	<li>
	<h5>X-Ray Test</h5>
	</li>
</ul>

X-rays provide detailed images of dense structures like bone. They are useful in ruling out elbow arthritis. 
&nbsp;

<ul>
	<li>
	<h5>Magnetic Resonance Imaging (MRI) Scan&nbsp;</h5>
	</li>
</ul>

MRI scans produce images of the body&#39;s soft tissues, such as muscles and tendons. An MRI scan may be requested to determine the extent of tendon damage or to rule out other injuries. If your doctor suspects you have a neck problem, they may order an MRI scan to see if you have a herniated disc or arthritic changes in your neck. Both of these conditions can cause arm aches and discomfort. 
&nbsp;

<ul>
	<li>
	<h5>Electromyography (EMG)</h5>
	</li>
</ul>

Your medical professional may request an EMG to rule out nerve compression. The majority of nerves run around the elbow. The signs and symptoms of nerve compression are identical to those of tennis elbow. 
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Treatment

Tennis elbow frequently heals on its own. Your doctor will first suggest one or more of the treatments listed below: 
&nbsp;

<ul>
	<li>
	<h5>Rest</h5>
	</li>
</ul>

It is critical to rest the arm. Resting your arm for several weeks is the first step in your recovery. A period of inactivity allows the cracks in the tendon to heal. 
&nbsp;

<ul>
	<li>
	<h5>Braces</h5>
	</li>
</ul>

Your doctor may advise you to wear a counterforce brace, a removable support brace. This tool relieves tension in tendons and muscles. 
&nbsp;

<ul>
	<li>
	<h5>Ice</h5>
	</li>
</ul>

Ice packs applied to the elbow can aid in reducing swelling and pain. Remember never to apply anything frozen or ice directly on your skin. 
&nbsp;

<ul>
	<li>
	<h5>Nonsteroidal Anti-Inflammatory Medicines (NSAIDs) </h5>
	</li>
</ul>

Over-the-counter medicine, for example, aspirin and ibuprofen, can aid in relieving pain and inflammation.

NSAIDs are available in the form of tablets, or as creams and gels (topical NSAIDs) which are applied directly to the painful area of your body. For musculoskeletal conditions such as a tennis elbow, topical NSAIDs are typically preferred over oral forms. Topical NSAIDS are advised due to their ability to reduce inflammation and pain without causing side effects such as <a href="https://merisehat.pk/disease/nausea">nausea </a>and <a href="https://merisehat.pk/disease/diarrhea">diarrhoea</a>. 
&nbsp;

<ul>
	<li>
	<h5>Physical Therapy</h5>
	</li>
</ul>

A physical therapist will use a variety of exercises to fortify your forearm muscles and encourage healing. Arm exercises, ice massage, and stimulating muscle techniques are some examples. 
&nbsp;

<ul>
	<li>
	<h5>Ultrasound Therapy</h5>
	</li>
</ul>

An ultrasound probe is placed over the most painful region of your arm during ultrasound therapy. The probe emits high-frequency sound waves into the tissues for a predetermined time. This type of treatment can aid in reducing inflammation and speeding up recovery. 
&nbsp;

<ul>
	<li>
	<h5>Steroid Injections</h5>
	</li>
</ul>

A doctor may recommend steroid injections if the symptoms are extremely painful and the condition makes movement difficult. Following a steroid injection, the individual should rest the arm and avoid putting undue strain on it.

However, steroid injections provide temporary relief, and their long-term efficacy is questionable. If they&#39;re effective, you may receive up to three injections in the same area, with at least a three to six-month intervals between them. 
&nbsp;

<ul>
	<li>
	<h5>Shock Wave Therapy</h5>
	</li>
</ul>

Shockwave therapy is a non-invasive treatment that involves passing high-energy shock waves through the skin to alleviate pain and promote movement in the affected region. The severity of your pain determines the number of sessions required. A local anaesthetic may be administered to alleviate any pain or discomfort during the procedure.

According to research, shockwave therapy can help relieve the pain of the tennis elbow in some occurrences<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>
	<h5>Platelet-Rich Plasma (PRP) Therapy</h5>
	</li>
</ul>

Platelets are small cell fragments found in your blood that help in healing. A medical professional withdraws a tiny amount of blood and separates platelets from other blood cells. The concentrated platelets are then injected into the injured area under ultrasound guidance. PRP is a promising treatment option being used by some doctors but it is not widely available. 
&nbsp;

<ul>
	<li>
	<h5>Strapping Or Taping The Forearm</h5>
	</li>
</ul>

Supporting the area can aid in the realignment of muscle fibres and relieve pressure on the site. A doctor may advise wearing a splint for two to three weeks to rest the elbow. 
&nbsp;

<ul>
	<li>
	<h5>Surgery</h5>
	</li>
</ul>

A person who has tennis elbow may require surgery if symptoms do not improve after a year of treatment. There are two kinds: 
&nbsp;

1. Open Surgery

Usually, open surgery is the method employed to repair a tennis elbow; it entails cutting the elbow. It is typically performed as an outpatient procedure, and it is rarely necessary to spend the night in the hospital. 
&nbsp;

2. Arthroscopic Surgery

Tiny cuts and small-scale instruments can also cure tennis elbow. Arthroscopic surgery is a same-day or outpatient procedure similar to open surgery. Both techniques remove any dead tissue and rejoin healthy muscle to the bone. Your arm may be immobilised with a splint following surgery. This is done to aid in the restoration of muscle strength and flexibility. 

Tennis elbow surgery is effective in 80 to 90% of cases<a href="#accordion">[4]</a>. However, it is common to experience some muscle weakness. Rehabilitation exercises are essential for recovery. 
&nbsp;

<h4>Surgical Risks</h4>

Tennis elbow surgery, like any other surgery, has risks. The following are the most common factors to consider:

<ul>
	<li>Infection.</li>
	<li>Damage to the nerves and blood vessels.</li>
	<li>Potentially prolonged rehabilitation.</li>
	<li>Strength loss.</li>
	<li>Loss of adaptability.</li>
	<li>The requirement for additional surgery. 
	&nbsp;</li>
</ul>

Tennis elbow pain might make working or engaging in physical activity difficult. The illness can also impair your grip, making it difficult to grab objects. However, tennis elbow, in general, does not create major long-term complications. 
&nbsp;

Several factors can raise the risk of tennis elbow. They include: 
&nbsp;

<ul>
	<li>
	<h5>Age</h5>
	</li>
</ul>

Tennis elbow can affect people of all ages, but it is most prevalent in adults aged 30 to 50. 
&nbsp;

<ul>
	<li>
	<h5>Occupation</h5>
	</li>
</ul>

Tennis elbow is more common in people with jobs requiring repetitive wrist and arm motions. Plumbers, painters, carpenters, butchers, and cooks are a few examples. 
&nbsp;

<ul>
	<li>
	<h5>Specific Sports</h5>
	</li>
</ul>

Tennis elbow is more likely to develop from playing racquet sports, especially if you use poor stroke technique. 
&nbsp;

Tennis elbow might be tough to avoid. Avoiding pressure on your forearm muscles might aid you in avoiding the ailment or keeping your symptoms from worsening. 
&nbsp;

<h5>Self-Care Advice</h5>

You can take the following steps to prevent tennis elbow from occurring or returning:

<ul>
	<li>Stop the painful activity, or discover another way to perform it that does not create pain or tension.</li>
	<li>Use your wrist as well as elbow less frequently than the rest of the arm. It might also aid in distributing the pressure to your shoulder&#39;s larger muscles.</li>
	<li>If you participate in a sport that requires repetitive motions, such as tennis or squash, obtain tutoring to assist you in changing or improving your technique.</li>
	<li>Before participating in a sport that requires repetitive arm motions, warm up correctly and gently loosen your arm muscles.</li>
	<li>To prevent additional strain on the tendons, utilise lightweight instruments or racquets with larger grip sizes.</li>
	<li>To prevent further injury to your tendons, apply a tennis elbow splint while utilising your arm (not while resting or sleeping). Consult your doctor or a physiotherapist about the appropriate brace or splint to use for strengthening the forearm muscles. 
	&nbsp;</li>
</ul>
<quillbot-extension-portal></quillbot-extension-portal>

Allogeneic Platelet-Derived Growth Factors Local Injection in Treatment of Tennis Elbow: A Prospective Randomized Controlled Study<a href="#accordion">[5]</a>. 
&nbsp;

This study aimed to determine the efficacy of local injections of allogeneic platelet-derived growth factors in the management of tennis elbow patients.

&nbsp;

The study comprised 120 tennis elbow patients randomly divided into two groups. The patients were locally administered either allogeneic growth factors (treatment group) or normal saline (control group). Patient-Related Tennis Elbow Evaluation (PRTEE) and fast Disabilities of the Arm, Shoulder, and Hand (qDASH) scores were used to assess the outcomes. Thus, clinical outcomes were graded as excellent, good, or poor. The patient&#39;s happiness and negative consequences were also documented. 
&nbsp;

This study concluded that local injection of allogeneic platelet-derived growth factors may be a potentially safe therapy option for tennis elbow, resulting in significant pain reduction, functional enhancement, and patient satisfaction. However, large scale research is needed to determine the long-term viability of these results. 
&nbsp;

Key Points

<ul>
	<li>Tennis elbow is a kind of tendinitis (tendon swelling) that induces pain sensation or discomfort in the elbow and arm.</li>
	<li>Tennis elbow is commonly caused by repetitive actions.</li>
	<li>Tennis elbow symptoms include discomfort and soreness in the bony knob (the lateral epicondyle) located on the exterior of your elbow.</li>
	<li>Tennis elbow can be avoided by minimizing overuse. If you get elbow pain while participating in an activity, stop and rest. 
	&nbsp;</li>
</ul>

[1] Finestone HM, Rabinovitch DL. Tennis elbow no more: practical eccentric and concentric exercises to heal the pain. Can Fam physician. 2008;54(8):1115–6.

[2] Buchanan BK, Varacallo M. Tennis elbow. In: StatPearls [Internet]. StatPearls Publishing; 2022.

[3] Stasinopoulos D, Johnson MI. Effectiveness of extracorporeal shock wave therapy for tennis elbow (lateral epicondylitis). Br J Sports Med. 2005;39(3):132–6.

[4] Admin. Tennis elbow treatment, exercises & surgery. Advanced Surgery Center

[5] Kandil MI, Ahmed A-SA-A, Eldesouky RS, Eltregy S. Allogeneic platelet-derived growth factors local injection in treatment of tennis elbow: a prospective randomized controlled study. Int Orthop. 2022;46(3):581–8.