Tennis elbow is a common musculoskeletal disorder of elbow and is usually an overuse injury. It is characterized by pain over the lateral elbow that is typically aggravated by gripping activities. Despite the name, tennis elbow, only 5% of all cases relate to tennis players. The syndrome is most prevalent (35-64% of cases) in jobs requiring repetitive wrist movements such as electricians, carpenters, gardener etc. It usually affects the dominant arm and is common between the ages of 35 and 50. Some of the common provoking activities are computer use, heavy lifting, repetitive vibration, forceful forearm pronation, and supination.
Tennis elbow is most commonly called lateral epicondylitis in medical term. However, numerous recent studies show the absence of inflammation in this disorder. Therefore, the terms, lateral epicondyalgia or epicondylar tendinopathy are more appropriate and are commonly used. Recent evidence suggests that the pain associated with tennis elbow is due to the impairments of the pain and motor systems as well as morphological changes in the structure of extensor carpi radialis brevis and common extensor tendon mechanism. In some cases, other extensor muscles, extensor carpi radialis longus, extensor digitorum and extensor carpi ulnaris are also involved.
Why do you get this lateral elbow pain?
Tennis elbow got its name because tennis involves repeated gripping and twisting movements of the wrist, which typically overloads extensor muscles. This action is more provocative in the backhand stroke when wrist extensor muscles have to work extensively from wrist flexion. Thus, tennis elbow injuries mostly occur if repetitive micro-trauma involves forces that the muscle tissues are unable to cope with. Numerous studies have reported the signs of neurogenic involvement, neovascularization, and changes in muscle morphology or degeneration or fiber necrosis in injured muscle fibers or tendon retinaculum.
Common activities causing tennis elbow
Sudden change or unaccustomed hand use. For example, painting a fence, hammering, excessive typing, change of firmness of bat or playing surfaces.
Excessive and repetitive wrist extension activities especially with forearm pronation.
Weak or tight forearm muscles.
Excessive gripping, wringing or vibrating activities.
Restricted range of motion of upper extremity joints. For example, restricted external rotation of the shoulder, restricted elbow and wrist flexion or extension.
A poor technique of hitting a ball, lifting objects or typing etc.
Referred pain from neck can mimic tennis elbow
There is a high incidence of tennis elbow like lateral elbow pain with the involvement of C5, C6 spine. The cervical spine pathology or c5, c6 nerve root involvement can transmit pain signals along the radial nerve. Thus, the radial nerve injury or reduced neural mobility can cause symptoms similar to tennis elbow. So, this neck dysfunction is usually ruled out before diagnosing tennis elbow.
Pain on the lateral epicondyle. Palpation on the extensor muscles origin on lateral epicondyle produces or increases pain.
Increased pain with provoking activities like resisted wrist extension, forearm pronation, wringing hand.
Radiation of pain along upper arm, the lateral side of the forearm, in chronic cases to the third and fourth fingers.
Reduced grip strength, especially with wrist extension.
Reduced flexibility and strength of wrist extensors and posterior shoulder muscles.