Don't let elbow pain spoil your summer

Many athletes and even non-athletes suffer from elbow tendonitis, known as epicondylitis, tennis elbow or golfer's elbow.  Note that tennis elbow is characterized by pain on the outside of the elbow, whereas golfer's elbow pain is on the inside. 

What is epicondylitis?

Epicondylitis is a tendon pathology characterized by localized pain on the outside of the elbow, at the tendon insertion point and more precisely above the joint, due to damage to the tendons attached to the epicondyle.

Anatomical reminder

The epicondyle is a bone in the upper arm, located on the humerus above the elbow and on the outside of the upper arm. The muscles linked to this bone play an important role in wrist extension and forearm supination, and work in parallel with the hand flexors to stabilize the wrist.

Causes and mechanisms of this injury 

Epicondylitis is frequently caused by repetitive movements of the forearm, resulting in a micro-tear or partial rupture of a tendon. Other causes of epicondyle pain include poor vascularization of the tendons attached to the epicondyle.  Certain daily physical activities, such as gardening, or sporting activities, such as tennis, are also known to trigger symptoms.

Symptoms 

Like all inflammatory pathologies, epicondylitis is characterized by pain and/or stiffness in the outer elbow on extension of the fingers and wrist.

Risk factors

• Age: this type of pathology mainly affects the 35 to 60 age group.
• Job type: workers with repetitive manual tasks are more prone to this problem.
• Sports: tennis, handball, basketball, table tennis, baseball.

Diagnosis

Clinical examination is important for detecting epicondylitis.

• Cozen's test: this specific test is performed by extending the hand in a pronated position from bottom to top, with slight manual resistance. The examiner touches the outside of the elbow with his thumb, and if pain is present, the test is positive.
• Maudsley test: this test is performed by extending the third finger of the hand in a pronated position. The examiner applies a slight resistance to the 3rd finger and the thumb to the outside of the elbow. 
• Complemeentary xamination: ultrasound can show the state of the tendons and possibly details of micro-tears and partial lesions.

Treatment

The treatment protocol basically starts with rest and stopping the activity that causes this type of pain.

Medical treatment

• The doctor may prescribe anti-inflammatory drugs 
• Corticosteroid infiltration is an option often used by doctors. These infiltrations must not be repeated, as the tendon becomes weakened. 

Acupuncture

• In the acute phase, acupuncture is a good way to control inflammation and pain.

Physiotherapy

Physiotherapy is the most widely recommended treatment:

• In the acute phase, Cryotherapy (icing) is recommended.  Applications lasting 15 to 20 min, 4 times a day
• Electrotherapy currents help reduce pain
• Laser offers metabolic stimulation and is the most powerful modality for controlling inflammation
• Shockwave treatment regenerates the body's tissues and accelerates healing times.  For chronic epicondylitis (pain lasting more than 3 months), shockwave treatment has demonstrated the best results.
• A forearm extensor stretching program is preferable.
• Once the pain is under control, static and dynamic strengthening of the forearm extensors and flexors is necessary to prevent recurrence.

Prevention

There are no fundamental rules for prevention, but it's advisable to warm up before any power work.

Conclusion

Tennis elbow remains a complex injury to treat.  A multidisciplinary approach is often recommended

 

By: Alain Scheldeman B.Sc. P.T, CAT(C)

Collaborator: Chafik Njeh, Therapist from Tunisia