Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis is an inflammatory reaction of the tendon that attaches the forearm muscles to the epicondyle, a bone located on the outside of the elbow.

Causes

The most common cause of lateral epicondylitis is overuse, brought on by repetitive movements executed at work or as part of a recreational activity. In most cases, the movements involve gripping actions of the hands, such as holding a tool or a tennis racket, or forearm rotation movements, such as using a screwdriver.

Other potential causes:

• Repetitive tasks executed with vibrating tools (in the construction industry, for ex.)
• Computer work requiring prolonged use of the mouse
• Direct trauma (fall, sudden impact, etc.), although this cause is less common.

Signs and Symptoms

• Pain at the elbow that gradually worsens;
• Pain felt on the outside of the elbow; if the injury is not treated, the pain can start radiating down the forearm and sometimes reach the wrist and hand (in severe cases, the index and middle fingers as well);
• Decrease in grip strength; the injured person may tend to drop objects;
• Weakened and painful gripping action;
• In more severe cases, there may be restriction of movements of 5 to 10° at the elbow.

Treatment

Acute stage:

• At this stage, it’s important to eliminate the activities that cause pain and to give the wrist a break. The physiotherapist may recommend wearing orthotics, such as a forearm brace, to lessen the transmission of stress to the tendon, or a splint to immobilize the wrist in a slightly extended position (for one to three weeks).

Subacute stage, or for chronic cases:

• Reduce pain and inflammation: ice, electrical nerve stimulation (TENS), laser, therapeutic ultrasound and interference current
• Massage and friction at the epicondyle muscle insertion point to reduce pain and tissue stress
• Stretching, strengthening and proprioception¹ exercises to lubricate the tendon and restore strength
• Taping neuroproprioceptif afin d’inhiber les muscles épicondyliens et de réduire la tension des tissus
• Neuro-proprioceptive taping to restrict the epicondyle muscles and reduce tissue stress
• Manual therapy to decrease tissue stress
• Shockwave therapy may be indicated in certain chronic cases.

Medical Treatment, to be determined by your Physician:

• Anti-inflammatories and pain relievers
• Injection of steroids (three maximum) in conjunction with physiotherapy; injections are sometimes used after physiotherapy, when the injury is not responding to treatment.

What to do to avoid a relapse

Because external epicondylitis is a consequence of repetitive tasks or movements, it’s very important to know how to avoid recurrences. Here are our therapists’ recommendations to help you stay healthy:

• Gradually get back into your previous activities;
• Take frequent rests while executing the repetitive movements; you should avoid prolonged, long term repetitive movements;
• Make sure your posture at work or during recreational activities is correct, since this could be the cause of your injury. If in doubt, ask your physiotherapist or occupational therapist to show you the proper posture. For example, a tennis player will usually avoid recurrences by learning how to hold the racket with the proper technique;
• In some cases, it will be necessary to consider changing activities, or at least to wear orthotics while executing the repetitive movements; however, it is very important to remove the orthotics as soon as the activity is over, or the muscles and tendons will start to weaken.

Do you think you may be suffering from external epicondylitis? Contact us to consult one of our health professionals.

Remember: the faster you get treatment, the better your chances of success!