Tennis elbow

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What are the causes of tennis elbow?

The cause of the tennis elbow is - generally speaking - overload of the extensor muscles of the wrist at the site of their attachments to the lateral epicondyle of the humerus. As a result of repeated overloads and microtraumas, degenerative changes occur in the area of ​​the extensor tendon. As a result of breaking the internal structure of tendons, cell and matrix degeneration occurs, collagen synthesis is disturbed, as well as vascular hypertrophy, which leads to the appearance of hypertrophic changes - vascular-fibroblastic hypertrophy. These changes cause increased muscle tension and even their shortening, which in turn causes even greater stress on their attachments. These complaints exacerbate the symptoms of tennis elbow, hence patients who are not treated properly can suffer from this condition for many years.

Tennis elbow or tendinitis?

For many years, pain at the tennis elbow has been associated with inflammation of the extensor tendinitis of the forearm (tendinitis). Today it is commonly accepted that pain is associated with degenerative changes in the area of ​​the extensor tendon - mainly the radial extensor muscle of the short wrist (tendidosis). The change in the direction of thinking took place in the 90s of the twentieth century, thanks to histopathological examinations, which did not confirm the presence of inflammation at the site of pain origin. However, they found changes resulting from microtrauma and degeneration of tendons as a result of overloading them. Not all scientists agree on this thesis. Unfortunately, in the literature, the term tendinitis (inflammation of the tendon) is still often used incorrectly, while the disease should be referred to as tendidosis (degenerative changes in the tendon). Meanwhile, to make an accurate diagnosis and determine the appropriate treatment, it is important to know the exact cause of the pain ..

How to recognize a tennis elbow?

 Pain from a tennis elbow appears on the lateral side of the elbow and may radiate to the dorsal part of the forearm and hand. Patients complain of increasing pain when straightening the fingers, wrist and elbow. Most often, severe pain occurs when lifting heavy objects, performing rotational movements - screwing or unscrewing (jars, screws, etc.), shaking hands when greeting. The pain may be so severe that some patients are unable to even lift a glass of water. Additionally, there may be weakening of the wrist strength and weakening of the functions of the upper limb.

Tennis elbow - diagnosis

In order to successfully treat a tennis elbow, a correct diagnosis is essential. The pain symptoms mentioned above do not always have to be associated with degenerative changes in the tendons. The cause of the pain may be, for example, a discopathy of the cervical spine, which causes a shoulder tear, in which pain - similar to a tennis elbow - radiates along the upper limb.

In order to make a correct diagnosis, the orthopedic doctor first conducts a thorough interview and then a physical examination. During the interview, the doctor should pay attention to the circumstances in which the pain appears and intensifies (activities such as turning, working at the computer, carrying heavy luggage, shopping, using a knife while cooking) and also ask if it had not happened immediately before it appeared. e.g. to change the way you train, buy a new mouse, change your computer keyboard or set up your desk.

The presence of the tennis elbow is also indicated by the pain increasing when trying to straighten the wrist, palpation tenderness in the area of ​​the lateral epicondyle and weakening of the grip strength. The doctor may also perform the Mill test (pain in the lateral epicondyle when you try to passively bend the fingers and wrists) and the Maudsley test (pain during the third finger resistance extension, with a straight elbow joint). Positive Mill and Maudsley tests indicate the presence of a tennis elbow. In addition, the doctor may refer the patient to ultrasound examinations, recommend an X-ray, magnetic resonance imaging or electromyography. These tests help to exclude causes of pain other than degenerative changes in the tendon (e.g. shoulder gout).

Who Has Tennis Elbow?

Contrary to its name, this disease does not only affect tennis players. Indeed, they are at risk - the cause of the pain is a late backhand or the “elbow guided” movement of the ball, which causes overload of the wrist extensor muscle attachments.

The vast majority of patients diagnosed with tennis elbow are people who do not play tennis. People who use the force of their hands in their work are primarily at risk of it, especially if they constantly perform the same movements, repeated many times. They will be, for example, builders, plumbers, mechanics, painters, carpenters, people working in production plants, seamstresses, musicians. A large group of patients are also people whose work is related to the constant use of a computer - programmers, computer graphic designers, office workers and even writers. Tennis elbow is also common among people actively involved in sports - exercising a lot in the gym, especially if they put an intense strain on the muscles of the forearms. This disease usually appears after the age of 40.

Tennis elbow - treatment

The process of treating a tennis elbow should begin with eliminating the cause of the pain. To reduce pain, you can apply temporary cold compresses as well as painkillers and anti-inflammatory agents. It should be remembered, however, that they will only provide short-term relief, without eliminating the cause of the pain.

First of all, it is recommended to limit the activities that provoke pain, but the limb should not be completely immobilized, as this may lead to muscle atrophy and delay the rehabilitation process. It is not always possible to stop the movements that cause pain - patients are forced to continue the work that contributed to the degenerative changes. Sometimes, however, a slight modification of the way you work is enough to relieve the muscles and achieve significant improvement. It is recommended to minimize the movements that stress the extensor muscles of the wrist and to avoid rotational movements - e.g. when screwing in and out. In the case of tennis players, the key role here will be played by improving the technique of hitting the racket, and in the case of people training a lot in the gym - improving the technique of lifting the barbell and using resistance machines. If the patient's work involves prolonged typing on the keyboard, he should ensure that his hands are properly positioned during work. The use of gel wrist pads can also help. However, each of these methods should be consulted with a physician or physiotherapist to avoid complications and aggravation of tendon degeneration through inappropriate use.

Physiotherapy in the treatment of tennis elbow

Physiotherapeutic treatments for tennis elbow are aimed at eliminating the cause of pain, improving limb function, and increasing muscle strength. The duration of treatment depends on the degree of degenerative changes and their nature. However, it should be remembered that physiotherapy will not regenerate degenerative changes. Pain relief can be provided by manual therapy or transverse massage. To relieve the extensor muscle attachments, kinesiotaping or special orthoses (tennis elbow support) are used - however, these are emergency measures and should not be used for too long to avoid muscle atrophy and, consequently, delay rehabilitation. A physiotherapist may also recommend exercises to stretch the extensor muscles.

Non-invasive methods of treating tennis elbow

Treatment of the tennis elbow is aimed at stimulating the regenerative processes. For example, shock wave therapy (ESWT) gives good results, which not only has an analgesic effect, but also stimulates the regeneration of degenerated fragments of the tendon.

Your doctor may also recommend that you give a plasma injection of concentrated platelets. Plasma is centrifuged from the patient's own blood and administered directly to the site of degenerative changes. Plasma supports the regeneration of damaged tissues.

Another minimally invasive method of treating tennis elbow is Topaz therapy. It consists in inserting an electrode through a small incision in the skin and influencing the diseased tissues with radio wave energy, which stimulates the regeneration processes of the damaged tendon.

In the recovery phase, it is also very important to involve the patient personally and to perform exercises appropriately selected by the doctor or physiotherapist, which are aimed at strengthening the forearm muscles and improving the grip strength and manipulation skills.

Anti-inflammatory drugs and tennis elbow

Since tennis elbow is not caused by inflammation, treatment today is not based on anti-inflammatory drugs. The new approach to the issue says that non-steroidal anti-inflammatory drugs not only do not cure the cause of pain, but also inhibit regenerative processes and thus delay the healing process. Hence, administration of both injections and anti-inflammatory ointments is avoided.

It is also not recommended to use steroid injections (the so-called blockade) to treat tennis elbow. Only in exceptional cases, in severe pain or a condition with acute swelling that prevents the patient from functioning, steroid injections are used as an emergency measure. Administration of steroids allows the patient to return to normal life, but can only be used for a short time. In other cases - when the patient can function normally - the administration of steroids is inadvisable. Steroids destroy collagen fibers and, consequently, can lead to even greater degenerative changes in the tendons. In addition, steroid therapy excludes biological treatment (plasma injections) and thus postpones the healing process.

Surgical treatment of tennis elbow

The current state of knowledge about the causes of the appearance of a tennis elbow allows, in the vast majority of cases, to be cured by non-invasive methods. Appropriate rehabilitation and involvement of the patient in performing the prescribed exercises and treatment prophylaxis give a good chance for complete regeneration of the degenerated tendons and elimination of the cause of pain without the need for surgical intervention. However, there are some cases when tennis elbow surgery is unavoidable. If, after one year of conservative treatment, the patient still suffers from pain or if the pain is so severe that it makes it impossible to function, the doctor will qualify the patient for surgery. Tennis elbow surgery consists in resection of necrotic foci from the area of ​​the attachment of the radial extensor tendons of the wrist. The operating physician's task is to remove the degenerated tendon fragments and clean the tissues. Sometimes it is also used to shift the attachment of the extensor muscle with the help of special anchors, which allows to relieve it. Surgical treatment of a tennis elbow is almost always a last resort and is used extremely rarely today. The surgery is effective in the vast majority of cases, and thanks to appropriate rehabilitation and postoperative prophylaxis, patients return to full fitness in the period of 3 to 6 months after the operation.

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