Tennis Elbow

Definition:
Tennis elbow is a condition where the outer part of the elbow becomes painful and tender, usually as a result of a specific strain or overuse. Although it is called “tennis elbow”, it is not restricted to tennis players –hyperextensions of the elbow, from whatever cause, can be classified as tennis elbow. Anyone who does a lot of work involving lifting at the elbow or repetitive movements at the wrist is susceptible to tennis elbow. The condition was first described in 1883.. The medical term is lateral epicondylitis.

Doctors first identified Tennis Elbow (or lateral epicondylitis) more than 100 years ago. Today nearly half of all tennis players will suffer from this disorder at some point. Interestingly though, tennis players actually account for less than 5 percent of all reported cases making the term for this condition something of a misnomer.

There are 2 additional strain related conditions which are often mistaken for Tennis Elbow. These being Golfer’s Elbow & Bursitis. Before we delve into the details of what Tennis Elbow actually is and options that are available for relieving & preventing the pain…let’s look at the distinguishing characteristics of each of these 3 ailments.


Tennis Elbow(lateral epicondylitis) Outside of Elbow:-
The onset of pain, on the outside (lateral) of the elbow, is usually gradual with tenderness felt on or below the joint’s bony prominence. Movements such as gripping, lifting and carrying tend to be troublesome.

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Golfer’s Elbow: (medial epicondylitis) Inside of Elbow
The causes of golfers elbow are similar to tennis elbow but pain and tenderness are felt on the inside (medial) of the elbow, on or around the joint’s bony prominence.

The condition is called Golfer’s elbow because in making a golf swing this tendon is stressed; many people, however, who develop the condition have never handled a golf club. It is also sometimes called Pitcher’s elbow due to the same tendon being stressed by the throwing of objects such as a baseball, but this usage is much less frequent. Apparently you can also get golfer’s elbow from serving in tennis.

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Bursitis: Back of Elbow
Often due to excessive leaning on the joint or a direct blow or fall onto the tip of the elbow.A lump can often be seen and the elbow is painful at the back of the joint.

Bursitis is the inflammation of one or more bursae, or small sacs of synovial fluid, in the body. Bursae rest at the points where internal functionaries, like muscles and tendons, slide across bone. Healthy bursae create a smooth and almost frictionless gliding surface. With hundreds of them throughout the body they provide this surface for all motion, making movement normally painless. When bursitis takes hold, however, movement that relies on the inflamed bursa becomes rough and painful. Movement of tendons and muscles over the inflamed bursa causes it to become more inflamed, perpetuating the problem.

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Symptoms of Tennis Elbow:-

*Pain on the outer part of elbow (lateral epicondyle).

*Gripping and movements of the wrist hurt, especially wrist extension and lifting movements.

*Tenderness to touch, and elbow pain on simple actions such as lifting up a cup of coffee or throwing a baseball.

*Pain usually subsides overnight.

*Recurring pain on the outside of the upper forearm just below the bend of the elbow; occasionally, pain radiates down the arm toward the wrist.

*Pain caused by lifting or bending the arm or grasping even light objects such as a coffee cup.

*Difficulty extending the forearm fully (because of inflamed muscles, tendons and ligaments).

*Pain that typically lasts for 6 to 12 weeks; the discomfort can continue for as little as 3 weeks or as long as several years.

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The damage that tennis elbow incurs consists of tiny tears in a part of the tendon and in muscle coverings. After the initial injury heals, these areas often tear again, which leads to hemorrhaging and the formation of rough, granulated tissue and calcium deposits within the surrounding tissues. Collagen, a protein, leaks out from around the injured areas, causing inflammation. The resulting pressure can cut off the blood flow and pinch the radial nerve, one of the major nerves controlling muscles in the arm and hand.

Tendons, which attach muscles to bones, do not receive the same amount of oxygen and blood that muscles do, so they heal more slowly. In fact, some cases of tennis elbow can last for years, though the inflammation usually subsides in 6 to 12 weeks.

Many medical textbooks treat tennis elbow as a form of tendonitis, which is often the case, but if the muscles and bones of the elbow joint are also involved, then the condition is called epicondylitis. However, if you feel pain directly on the back of your elbow joint, rather than down the outside of your arm, you may have bursitis, which is caused when lubricating sacs in the joint become inflamed. If you see swelling, which is almost never a symptom of tennis elbow, you may want to investigate other possible conditions, such as arthritis, infection, gout or a tumor.

If no treatment given, can become chronic and more difficult to eradicate.

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Exams and Tests:-
The diagnosis is made by clinical signs and symptoms, since x-rays usually show no abnormality. Often there will be pain or tenderness when the tendon is gently pressed near where it attaches to the upper arm bone, over the outside of the elbow.

There is also pain near the elbow when the wrist is extended (bent backwards, as when applying a motorcycle’s throttle) against resistance.

Treatment:
The goal of treatment is to relieve pain and swelling. Treatment may include:

Nonsteroidal anti-inflammatory medications (such as ibuprofen, naproxen or aspirin)
Local injection of cortisone and an numbing medicine
Using a splint to keep the forearm and elbow still for 2 to 3 weeks
Heat therapy
Physical therapy
Pulsed ultrasound to break up scar tissue, promote healing, and increase blood flow in the area
To prevent the injury from happening again during aggravating activities either a splint may be worn or only limited participation in the activity undertaken. If the pain persists despite non-surgical treatments, surgery may be necessary.

Although not founded in clinical research , the tennis player’s treatment of choice is frequent icing and compression (Cold compression therapy) for inflammation, and taking anti-inflammatory pain-killers, such as ibuprofen. In general the evidence base for intervention measures is poor. A brace might also be recommended by a doctor to reduce the range of movement in the elbow and thus reduce the use and pain. Also, ergonomic considerations are important to help with the successful relief of lateral elbow pain.

Relief Of Tennis Elbow:-

Initial measures
Rest, ice, and compression are the treatments of choice. There are many excellent cold compression therapy products available. Nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce pain and inflammation.

The best way to relieve tennis elbow is to stop doing anything that irritates your arm — a simple step for the weekend tennis player, but not as easy for the manual laborer, office worker, or professional athlete.

The most effective conventional and alternative treatments for tennis elbow have the same basic premise: Rest the arm until the pain disappears, then massage to relieve stress and tension in the muscles, and exercise to strengthen the area and prevent re-injury. If you must go back to whatever caused the problem in the first place, be sure to warm up your arm for at least 5 to 10 minutes with gentle stretching and movement before starting any activity. Take frequent breaks.

Conventional medicine offers an assortment of treatments for tennis elbow, from drug injections to surgery, but the pain will never go away completely unless you stop stressing the joint. Re-injury is inevitable without adequate rest.

For most mild to moderate cases of tennis elbow, aspirin or ibuprofen will help address the inflammation and the pain while you are resting the injury, and then you can follow up with exercise and massage to speed healing.

For stubborn cases of tennis elbow your doctor may advise corticosteroid injections, which dramatically reduce inflammation, but they cannot be used long-term because of potentially damaging side effects.

Another attractive option for many sufferers, especially those who prefer to not ingest medication orally, is the application of an appropriate and effective topical anti-inflammatory. CT Cream with A.C.P. was specifically designed to reduce inflammation and does so by taking advantage of well known elements Arnica, Choline, Pyridoxine and Vitamin B6. Researched, formulated and introduced recently by Dr. Ying Lee, CT Cream has proven to be extremely successful in treating inflammation related ailments such as epicondylitis, tendonitis, bursitis & carpal tunnel syndrome.

If rest, anti-inflammatory medications, and a stretching routine fail to cure your tennis elbow, you may have to consider surgery, though this form of treatment is rare (fewer than 3 percent of patients). One procedure is for the tendon to be cut loose from the epicondyle, the rounded bump at the end of the bone, which eliminates stress on the tendon but renders the muscle useless. Another surgical technique involves removing so-called granulated tissue in the tendon and repairing tears.

Even after you feel you have overcome a case of tennis elbow, be sure to continue babying your arm. Always warm up your arm for 5 to 10 minutes before starting any activity involving your elbow. And if you develop severe pain after use anyway, pack your arm in ice for 15 to 20 minutes and call your doctor.
Alternative treatments:-
Laser Therapy
The Use of Laser Therapy (Low Power or Low Intensity Laser Therapy) is a currently used treatment. The approach was spun off of research on how light affects cells. The findings, that light stimulates and accelerates normal healing, sparked the creation of several devices. The dosage often determines the extent of the success with this treatment, so it is generally recommended that experienced clinicians apply the therapy with a device that can be ‘customized.’ Professional athletes have used the therapy and it has gained attention in the media lately, on shows like the Canadian health program “Balance” on CTV. However, studies evaluating the efficacy of laser therapy for tennis elbow are currently contradictory.

One study has alleged that electrical erin stimulation combined with Acupuncture is beneficial but evaluation studies are inconclusive .

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Prognosis :-
Most people improve with non-surgical treatment. The majority of those that do have surgery show an improvement in symptoms.

Prevention:-
To prevent tennis elbow:
*Lift objects with your palm facing your body.

*Try strengthening exercises with hand weights. With your elbow cocked and your palm down, repeatedly bend your wrist. Stop if you feel any pain.

*Stretch relevant muscles before beginning a possibly stressful activity by grasping the top part of your fingers and gently but firmly pulling them back toward your body. Keep your arm fully extended and your palm facing outward.

CAUTION!
To prevent a relapse:
Discontinue or modify the action that is causing the strain on your elbow joint. If you must continue, be sure to warm up for 10 minutes or more before any activity involving your arm, and apply ice to it afterward. Take more frequent breaks.
Try strapping a band around your forearm just below your elbow. If the support seems to help you lift objects such as heavy books, then continue with it. Be aware that such bands can cut off circulation and impede healing, so they are best used once tennis elbow has disappeared.

Call Your Doctor If….
The pain persists for more than a few days; chronic inflammation of the tendons can lead to permanent disability.
The elbow joint begins to swell; tennis elbow rarely causes swelling, so you may have another condition such as arthritis, gout, infection or even a tumor.

Possible Complications:-
Recurrence of the injury with overuse
Rupture of the tendon with repeated steroid injections
Failure to improve with nonoperative or operative treatment; these may be due to nerve entrapment in the forearm.

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Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.tennis-elbow.net/tenniselbow.htm
http://en.wikipedia.org/wiki/Tennis_elbow

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