TENNIS ELBOW

Tennis Elbow, also known as lateral epicondylitis is an extensor tendinopathy which involves ECRB tendon. Its an overuse injury resulting from repeated use of wrist extensors and is commonly experienced by plumbers, gardeners, cleaners, carpenters, mechanics, bowlers, baseball players and tennis players.

The symptoms usually involves pain radiating from the lateral aspect of the elbow to the forearm and back of the hand when grasping or twisting or lifting heavy objects.

Mill's and Cozen's tests are the special tests used to diagnose the tennis elbow in which when the long extensors of wrist are stressed, it causes pain on the lateral epicondyle of the elbow which is the origin of the common extensors.

Physical Therapy Treatment goals
a) Pain reduction- Cold therapy in the form of ice packs (for approx. 15Mins, 2 times a day) Therapeutic Ultrasound, Iontophoresis using NSAIDS or corticosteroids.

b) Activity modification- Avoid pain aggravating activities, Change in technique or ergonomic changes at work station to reduce load on wrist extensors.

c) Counterforce bracing- To reduce stress on the common extensor origin. Its worn 10cm distal to the elbow joint on the proximal forearm.

d) Exercise therapy- To stretch and strengthen the muscles of the forearm and to maintain the flexiblity of the muscles of the forearm.
1. Gentle streching exercises of wrist flexion, extension and rotation with elbow in extension. Avoid vigrous stretching and stretching to the point of pain. Maintain the stretch for 15- 20 seconds.
2. Strengthening of wrist flexors, extensors, ulnar and radial deviators alongwith supinators and pronators with elbow flexed and forearm supported using weight cuffs or dumbbells. These exercises can be started in gravity eliminated plane and later on can be progressed to against gravity activities.
3. Isometric finger extension(using a rubber band around fingers) and flexion exercises(by squeezing a tennis ball).
4. In later stages, focus should be on eccentric contractions of the wrist extensors.


Other treatment options (for chronic cases)
Steroid injections
Surgery- If 6 months of conservative treatment fails or at the discretion of the orthopaedician.