• Robin R Varghese, PT.

No! Tennis ain't bad at all !!!! Is the pain on the lateral aspect of your elbow bothering you?


Tennis Elbow, which was known as Lateral Epicondylitis is lately proposed as Lateral Elbow (or Epicondyle) Tendinopathy (LET).

It is the most common overuse syndrome in the elbow.

It is a tendinopathy injury involving the extensor muscles of the forearm. These muscles originate on the lateral epicondylar region of the distal humerus.


only 5% of people suffering from tennis elbow relate the injury to tennis!

Sportsmen playing other sports such as squash, badminton, baseball, swimming and field throwing events too get LET.

People with repetitive one-sided movements in their jobs such as electricians, carpenters, gardeners, desk bound jobs also commonly present with this condition.


Cause

  • Contractile overloads that chronically stress the tendon near the attachment on the humerus are the primary cause of LET.

  • It occurs often in repetitive upper extremity activities such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration.

  • This injury is often work-related, any activity involving wrist extension, pronation or supination during manual labor, housework and hobbies are considered as important causal factors.

  • Other risk factors are overuse, repetitive movements, training errors, misalignments, flexibility problems, ageing, poor circulation, strength deficits or muscle imbalance and psychological factors.

What exactly happens?

  • LET is an overuse injury that may result in hyaline degeneration of the origin of the extensor tendon.

  • Overuse of the muscles and tendons of the forearm and elbow together with repetitive contractions or manual tasks can put too much strain on the elbow tendons.

  • These contractions or manual tasks require manipulation of the hand that causes mal-adaptations in tendon structure that lead to pain over the lateral epicondyle.

  • Mostly, the pain is located anterior and distal from the lateral epicondyle.

  • Most commonly, the extensor carpi radialis brevis (ECRB) is involved, but others may include the extensor digitorum, extensor carpi radialis longus (ECRL), and extensor carpi ulnaris.

Various opinions on the cause for LET


  • Inflammation (which occurs at the earlier stage of the disease),

  • Microscopic tearing (leading to structural failure of muscle),

  • Degenerative process (with the increase in fibroblast and disorganized and matured collagen within the tendon) and

  • Hypovascularity (leading to decline in functional tolerance of the muscle) are some of the opinions regarding the cause.


Symptoms

  • The most prominent symptom of LET is pain and tenderness.

  • Pain during, immediately after and after prolonged hours of provocative activity.

  • The pain can radiate upwards along the upper arm and downwards along the outside of the forearm and in rare cases even to the third and fourth fingers.

  • Reduced or deficient flexibility and strength in the wrist extensor and posterior shoulder muscles.

  • Constant pain, which prohibits any activity.

  • Weakness in their grip strength especially with the elbow extended.

  • Treatment

Non surgical

  • Rest

  • Activity modification

  • Elbow counterforce brace

  • Physical Therapy

  • NSAIDs

  • Steroid and hyaluronic acid injections as per your physician’s advice.

Surgical

Open or Arthroscopic surgeries are done in case Non- surgical measures fail for more than 6 months.

Physical Therapy Management

This includes:

  • Education/Advice on pain control and/or modification of activities

  • Modalities- Ice, Massage, Ultrasound, Transcutaneous Electrical Nerve Stimulation (TENS), Laser, Shockwave Therapy

  • Supervised Exercises- Strengthening and Stretching

  • Deep Transverse Friction Massages

  • Manual therapy- Mulligan - Mobilization with movement

  • Taping

  • Sport/Occupation Specific Rehabilitation


We at Valley Healing Hands, Brownsville, Texas provide the best Physical Therapy and Occupational therapy treatment for Lateral Epicondyle Tendinopathy/Tennis Elbow/ Lateral epicondylitis as we have the best therapist who can evaluate and diagnose you using various diagnosing tests and help you get over your pain and to get back to you favorite activity with much vigor and enthusiasm.








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