Tennis Elbow (AKA Lateral Epicondylitis)

Heres some info on what is probably the most common overuse injury and a frequent cause of elbow pain:

Tennis elbow is a painful condition on and around the bony part (epicondyle) on the outside (lateral side) of the elbow. When the tendons attached to this bone are overused, they can deteriorate and become inflamed and painful. It’s commonly called tennis elbow, but it is not restricted to people who play tennis. It occurs in people who do manual labor with their hands, such as roofers and carpenters. It causes pain and tenderness in the bony bump on the outer part of the elbow. The condition commonly occurs between the ages of 30 and 60, with the most frequent incidence appearing in patients in their 40s.

When you repeatedly overuse the forearm muscles that straighten and raise the hand and wrist, the condition can appear. By overusing the muscle, tendons become inflamed and small tears in the tendon tissue can occur. These muscles then may strain and irritate their attachment at the bone on the outside of the elbow.

What Causes of Tennis Elbow?

It can be caused by other activities besides playing racquet sports. Many commonplace activities can strain the tendons, such as:

• Painting
  
• Carrying heavy items
  
• Golf
  
• Carpentry
  
• Typing
  
• Knitting
  
• Machine Work
  
• Tennis

Basically, any activity that twists and extends the wrist can lead to tennis elbow. In rare circumstances, a direct blow to the outside of the elbow can also lead to the condition but mostly, as already mentioned, its an overuse injury.

What are the symptoms of Tennis Elbow?

The first sign of tennis elbow is usually tenderness and pain when pressure is applied to the outside of the elbow. If left untreated, a dull constant pain or sharp shooting pain can be felt. Swelling may be present. Other symptoms include:

• Pain when the wrist or hand is straightened
  
• Pain felt when lifting a heavy object
  
• Pain when making a fist or shaking hands
  
• Shooting pains from the elbow down to the forearm or up into the upper arm

Sometimes other conditions that are not linked to tennis elbow can cause pain in the elbow. For example, arthritis of the elbow, a pinched nerve in the neck and carpal tunnel syndrome are other conditions that cause similar symptoms. Your doctor will be able to accurately diagnose your condition by asking you about your daily and recreational activities and examining your elbow and arm. You will probably have to do movements that cause pain in the outer part of the elbow. In addition, he or she may order X-rays or even an MRI of the elbow.

Treatment

• Rest – Don’t do anything that aggravates the pain
  
• Ice – Use an ice pack and perform an ice masseage.
  
• Anti-inflammatory medications - Your physician may prescribe an anti-inflammatory medication, like ibuprofen, to reduce the swelling.
  
• Cortisone injection – the doctor may also inject cortisone directly to the area to reduce the pain.
  
• Elbow strap +/- a splint  - can be worn just below the elbow to provide support to the area. To limit the movement of the stressed muscles and tendons, a splint that immobilizes the wrist could also be used.
  
• Physical therapy exercises (see below) - designed to strengthen the forearm muscles. Many patients start to respond a week or two after they have started treatments.
  
• Surgery -  If the condition does not respond to the above treatments, surgery may be necessary. Surgery is usually performed on an outpatient basis. An incision is made on the outside of the elbow, and the surgeon will explore the tendons and may remove tissue that has degenerated. He or she may have to cut the tendon at its attachment to the bone and remove a small portion of the bone to improve the blood supply to the area.

Tennis elbow rehabilitation

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation exercises for tennis elbow often includes 2 main types of exercises: 

• Stretching - When the acute pain is gone, start gentle stretching of the wrist and elbow as recommended by your doctor. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times.
  
• Strengthening - Begin strengthening exercises for your wrist extensor muscles as recommended by your doctor.

Rehabilitation exercises

The major objectives of rehabilitation from tennis elbow are to improve the elasticity of the elbow joint and to gradually increase pain-free range of motion. The exercises below stretch the muscles of the forearm and upper arm. These exercises should be performed once or twice daily.

Stretching exercises

• Wrist flexor stretch
  Extend affected arm forward with palm up and elbow straight. Place fingers and palm of opposite hand across palm and fingers of the extended hand and draw back with it until stretch is felt in the forearm. Hold this position for 3 to 5 seconds, then relax for 3 to 5 seconds. Perform this exercise 10 times.
  
• Wrist extensor stretch
  Extend affected arm forward with palm down, elbow straight, and fingers slightly curled. Grasp the affected side hand with other hand and draw affected side hand down until stretch is felt in the forearm. Hold this position from 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
  
• Pronation/suppination stretch
  Extend affected arm forward in a hand-shaking position with palm facing up. Slowly rotate the hand from a palm-up position to a palm-down position. Hold for 3 to 5 seconds and then rotate back. Perform this exercise 10 times. When you work your way up to strength training, you may use a small weight while rotating the hand and wrist.
  
• Tricep stretch
  Stand erect with feet at about shoulder width. Raise injured arm at the shoulder with elbow bent and place the forearm behind the head. Grasp the injured elbow with opposite hand and draw it toward the center of the body until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times.
  
• Bicep stretch
  Stand erect with arms raised to shoulder height and palms up. Press arms backward until stretch is felt. Hold this position for 3 to 5 seconds then relax for 3 to 5 seconds. Perform this exercise 10 times. The bicep is stretched by this exercise as well as the muscles of the shoulder and upper chest.

Strengthening exercises

The following exercises develop strength of the muscles of the forearm and upper arm. To maintain symmetry of the arms in terms of strength and appearance, perform these strength exercises with the uninjured arm as well as the injured arm.

• Wrist extension
  Sit in a chair with forearm resting on the end of a table, palm down. Grasp a light weight dumbbell and raise the weight up as high as possible while maintaining contact with the table top. Hold this position for 3 to 5 seconds. Relax for 3 to 5 seconds. Repeat this exercise 5 to 10 times. Substitute a heavier dumbbell as strength increases.
  
• Arm curls
  Either standing or sitting, grasp a 2- to 4-pound dumbbell in one hand. With palm up, flex elbow and draw the dumbbell up to the same side shoulder while maintaining erect posture. Do not bend at the waist or swing the dumbbell. Lower dumbbell slowly and with control to the starting position. Repeat this exercise 10 times. Use a heavier dumbbell as strength increases

Thanks for the post man.

I literally just got back from the doctor with this diagnosis.  As a precaution, *don't do any of the exercises until your doctor says so.*  Everyone's case is different.  In my case, I got the condition from violin/viola playing.  To avoid over-use, he encouraged me to continue to play (but not if it hurts), and to ice after every session for 15-20 minutes, but NOT to do any other exercises at this point.  Because the elbow is so essential to good playing, his approach is very conservative; the last thing he wants to do is to have to inject steroids, and God forbid surgery.  I will find out what happens in two weeks.

And oh yeah, no lifting that involves the arms.  Damn.  At least he didn't forbid me from going to the gym all together!

"If there's nothing else that's relevant, I'll be leaving now"

"Today's mighty oak is just yesterday's nut that held its ground"

While i dont mean to disagree with the doctor, it has to be said that a weak point for most doctors is rehabilitation of injuries. Exercises are quite essential in rehabilitation of injury. That doesnt necessarily mean RESISTANCE exercises but defintely STRETCHING routines are employed in just about every injury - pre/post surgery.
 
For those who suffer from this, gzinkls doctor is right - lay off the weights. But it is essential that you continue to stretch the tendons once the pain has died down a little. Avoid the strengthening exercises until you have no pain at rest, but a little bit of pain is ok for stretching purposes. And again, as gzinkl said, after every stretching session, make sure you ice it.
 
Granted steroid injections are not pleasant but they have been shown, according to many studies, that if used in the acute setting when the pain has come up quite recently, they are quite beneficial.
 
As for surgery, it is the last option and avoided as much as possible. But there are defintely cases where the conservative treatment just doenst work, despite the best efforts of your health care provider. There actually have been some prominent sportpeople who have had the displeasure of having to got through with surgery. I guess it all comes down to how badly you want a quick fix for your elbow and what you are willing to sacrifice/put up with it.

It's not that he doesn't want to rehabilitate me, he doesn't want me to over-use it.  Believe me, I quizzed him on stretching and resistance exercises (this all came up on a viola list group I belong to, and the stories we heard . . .=8O  ).  Playing the violin or viola involves the following:  at least 1 hour of daily practice, the left arm is heavily involved--moving fingers is really moving your forearm muscles.  And then there's the vibrato, and the shifting.  It's like being on a treadmill, except you have four of them, and you have to keep hopping back and forth between them, keep running, and shake your ass at the same time.  That's an hour of stretching exercises right there.  Rehearsals are 3-4 hours, twice a week.  Lessons are an hour, once a week.  That's 15 hours of stretching/week; add a concert in there with a warm up rehearsal adds another 3+ hours.  I will give up almost anything else but playing music, unless I absolutely have to.  I expect I'll croak with a violin or viola under my chin, but a smile on my face.

For the steroid injections, there were two things I learned:  you can only receive a few steroid shots in a joint over your lifetime, so save them up!  And there is the potential for nasty side effects, including deposit formation, which sounds just as painful. 

This injury can be debilitating and can ruin the use of your arm forever, ending training careers, or in my case, playing music.  These are the reasons for my caution.  My doctor also wanted to be able to present me to the rehabilitation institute's musician therapists experts as unharmed, but as helped, as much as possible, if that need should arise.  Let's hope not!

"If there's nothing else that's relevant, I'll be leaving now"

"Today's mighty oak is just yesterday's nut that held its ground"

i have absolutely NO idea about whats involved in viola/violin stuff, so ill just take your word for it.

  you can only receive a few steroid shots in a joint over your lifetime, so save them up

What exactly are you saying them up for? Like you said, it can be very debilitating so why not use symptom-relief when you can?

And as for receiving only a few injections over your lifetime, where did you get that info from? Its not that your body cant COPE with more than a few. The reason doctors dont give it too often to the same person is because if youre requiring that many imjections, then obviously something isnt going right and the doctors have to go back to the working board and figure out what else can be done so you dont have the pain so often that you require injections.

  And there is the potential for nasty side effects, including deposit formation

Did your doctor tell you this? Because the most common side effects include allergic reactions, ,  joint swelling and pain several hours after the corticosteroid injection (1 in 50), depigmentation of the skin, Infections (extremely rare - less than 1 in 15,000) and if injected directly into a tendon, instead of a joint, then you may get a ruptured tendon. Ive never read anywhere about deposit formation - mainly because the substances used these days to inject are extremely soluble.

Repeated injections into the same joint should be avoided, true, but corticosteroids are only for short-term inflammatory relief and are adjuvant therapy (i.e should only be used ON TOP OF other conservative treatment). So like i said, if its needed more than a few times, it means the rehab isnt going well and other measures need to be considered.

Well, the condition has been further diagnosed.  The condition acted like tennis elbow, but the cause is a benign bone tumor that has invaded the joint.  Ouch.  Thank God for MRI's.

"If there's nothing else that's relevant, I'll be leaving now"

"Today's mighty oak is just yesterday's nut that held its ground"

Thank goodness you went in to see the dr!!  Let this be a lesson to all of you who ask about injuries here and don't get it checked out..................be safe or you can end up worse off than you suspect.
This was a good ending.

Come Visit my websites! www.figureteam.com www.lindacusmano.com www.bodyrushpersonaltraining.com

ORIGINAL: Italianangel

Thank goodness you went in to see the dr!!  Let this be a lesson to all of you who ask about injuries here and don't get it checked out..................be safe or you can end up worse off than you suspect.
This was a good ending.

Actually, the total number of medical professionals that were consulted:  2 MD's, 2 chiropractors and a massage therapist.  There might be an acupuncturist thrown in soon, too.  My insurance company must be reeling!  For the record, it was the 2nd chiropractor who caught it.

"If there's nothing else that's relevant, I'll be leaving now"

"Today's mighty oak is just yesterday's nut that held its ground"

Even better point, seek as many drs as you need, you know your body and need to find out what is wrong if it feels like something is wrong!!

Come Visit my websites! www.figureteam.com www.lindacusmano.com www.bodyrushpersonaltraining.com

I'm prone to both tennis elbow and golfer's elbow in both arms.  Lucky me. 
 
The doctor I went to years ago, a sports doc btw, said to lay off lifting.  Yeah OK, as if.  Instead of completely laying off, I took a rest, but then I found other movements that didn't aggravate my elbow.  For example, dumbell curling with a pronated grip was out.  So I discovered I could do hammer curls and curls with an EZ bar.  Slightly different, but hey!  I also got my hands on a couple of elbow braces, the best one being this little doodad... http://www.elbowaid.com/