Tennis Elbow Treatment

Medically Reviewed By : Dr Sravya, MBBS, MS

Overview

Treatment of tennis elbow is significant as it cannot not recover overnight and might take upto 6 to 12 months to heal depending on the severity of the injury. Tennis elbow or lateral epicondylitis or lateral epicondyle tendinopathy (LET) is named after the elbow pain which is observed among in tennis players, but many more people other than sportspeople, including cooks, dentists, musicians, painters, carpenters, plumbers, and other manual laborers can also get affected by this condition. Lateral epicondylitis is a painful overuse injury that occurs to the elbow.

Repetitive and vigorous forearm movements can cause injury to the tendon and forearm muscles. This injury gives you pain in your elbow region. In this article, we will see in-depth about its signs, symptoms, diagnosis and both medical treatment of tennis elbow as well as tennis elbow treatment at home.

In This Article

What is tennis elbow?

Tennis elbow, before going into it, let’s look into the anatomy of our elbow joint. The elbow joint is made up of three bones, the upper arm bone (humerus) and two forearm bones (radius and ulna). In the lower end of the humerus bone, there are two epicondyles, one medial and one lateral. The tendon connects muscles to the bone. The area of pain is at the lateral epicondyle. Usually, along with the extensor muscles of the forearm, the tendon, extensor carpi radialis brevis (ECRB) is involved, but others may also include such as the extensor carpi radialis longus, extensor digitorum, and extensor carpi ulnaris.

Tennis elbow or lateral epicondyle tendonitis is an inflammation of the tendons in the epicondyles. The inflammation can be resulting from overstraining the muscles and tendons of the forearm. There may be a partial tear of the tendon fibers at or near its origin. This produces pain in the outer part of the elbow.

What could be the signs and symptoms of tennis elbow?

Treatment of tennis elbow will be decided upon the signs and symptoms shown by a particular individual.

Symptoms may include:

Signs one may find:

How to treat tennis elbow?

Treatment of tennis elbow can be by various methods which include both non-invasive and surgical procedures. Here will see all the types of treatment in detail.

Non-operative medical treatment for tennis elbow

Non-operative or non-invasive procedures are always the initial choice opted by the physicians to treat tennis elbow. This method aims to relieve pain and inflammation of the site.The treatment include:

Medications: NSAIDs are given to the patient with tennis elbow to reduce pain and inflammation. Ice pack application is also advised. If any swelling is present, you can elevate the extremities.
An elbow counterforce brace: A brace is worn around the forearm and is tightened so that the wrist extensor muscles won't fully contract when the patient moves the arm. By using an elbow counterforce brace for the treatment of tennis elbow, pain due to the contraction will be relieved.
Injections: Steroid and hyaluronic acid injections are said to be effective for treating tennis elbow. The injections are given subperiosteally and should not be repeated more than 2 times. The steroid injection usually increases the pain for the first few hours. These injections and physiotherapy can help. A rest for 1 to 2 weeks followed by the injection is always advised.

Surgical treatment

Surgery is considered as the treatment of tennis elbow only when the non-operative medical treatment for about 6 months has shown not much progress in recovering from the injury. The surgery is aimed to repair the injured muscle or to remove the injured part of a muscle, then reattach it back to the bone.

General Physiotherapy

The general physiotherapy treatment of tennis elbow includes education on pain control and modifying activities, massage, transcutaneous electrical nerve stimulation (TENS), laser, shockwave therapy, supervised exercises such as strengthening and stretching, sport or occupation specific rehabilitation. Let us see more details about some physiotherapy techniques used for tennis elbow.

Extracorporeal Shockwave therapy: In this procedure, a strong mechanical wave impulse is exposed to the patient’s injury. It is reported as safe, but in high doses can damage the soft tissues by cavitation.
Cyriax Physiotherapy: Cyriax physiotherapy is a procedure for tennis elbow which uses both deep transverse friction with Mill’s manipulations. Patients must follow this physiotherapy three times a week for four weeks.
Deep Transverse Frictions: It is a procedure where a specific massage to the connective tissues is applied precisely. It aims to maintain mobility within the soft tissue structures. Analgesics are given before the patient for numbing effect, after which the therapist must try deep transverse friction. Firstly identify the area of pain, and apply pressure with the tip of the thumb on the lateral condyle in a posterior direction. A 48-hour interval should be between two sessions.
Mills Radial Head Manipulation: This is the most common technique used by physiotherapists for tennis elbow treatments. The aim is to elongate the scar tissue by rupturing adhesions and making the area more mobile and painless. A high-velocity small-amplitude thrust is applied at the end of elbow extension while wrist and hand are flexed. To prevent symptoms from worsening, full wrist flexion and fully pain-free elbow extension must be achieved during the procedure. This may produce mild discomfort for an instant. 2-3 times a week with upto 4-12 sessions is usually advised.

Exercise therapy

The purpose of exercise therapy is to restore normal musculoskeletal function or to reduce pain that is caused by diseases or injuries. Combinations of exercise and manipulation or exercise and stretching may help in pain relief.

Stretching: Stretching and strengthening exercises are the most important components of these exercise programmes. The main aim of stretching is to lengthen the tendons. The stretching position for the Extensor Carpi Radialis Brevis tendon is achieved in elbow extension, wrist in flexion and ulnar deviation of the wrist. The stretching has to be done before eccentric exercises and during treatment sessions rest intervals.
Eccentric exercises: These exercises have three principles. They are load or resistance, speed or velocity, and frequency of the contractions.

(i) Load (or resistance), here, the basic principle of progressive overload is that increase in the load ensures that the tendon is subjected to greater stress making it stronger.
(ii) The speed (velocity) of contractions is also a fundamental principle in which the speed of the eccentric exercise should be increased.
(iii) The frequency of contractions is the third principle of which is the variations of sets and repetitions of exercise.

Theraband Exercise

In this, you have to fix the one side of the theraband under your feet or any place and take the other side in your hand. The patient starts the exercise in wrist flexion, then a wrist extension and very slowly comes back to the start position. A 3 sets of 10 has to be performed daily. Supervised exercise consists of static stretching and eccentric strengthening. These exercises for 4 weeks are reported to have higher effects in reducing pain and function. Once the patients can do this, they can progress to another colour of theraband with greater strength. Theraband exercises (or exercises with a small weight) are to be performed daily for 3 sets of 10.

Taping

This can be included as a tennis elbow treatment at home and taping will help to reduce pain as well as improve functional performance. A rigid tape can be used which will reduce stress and support the forearm. The size and shape of the tape, as well as the location of the tape to be stuck, have to be tailored for each individual according to the severity. Using this tape and resting at home will be helpful.