Crisis Plan Series
Tennis elbow
Tennis elbow is a very difficult condition to treat especially when it is left to become chronic (long-standing). Making the best possible differential diagnosis to find out the exact injured structure is important to increase the prognosis (chance) of recovery. It is a term loosely used for lateral (outside) elbow pain. The source of symptoms could be one of the injuries from the: forearm extensor tendons, muscles, lateral epicondyle (bone), the collateral ligament, the lateral (outside) aspect of the elbow joint, radio-humeral joint, superior radio-ulnar joint, refer pain from the cervical (neck) spine or neural (nerve) hypomobility.
The treatment approach can be very different when treating different 'types' of 'tennis elbow'. Let's assume that we are dealing with the typical tennis elbow, tendonitis (inflammation of the tendon) . Other than the required medications, mechanical treatment should be given as soon as possible at its acute stage. Since the cause of the injury is often due to repetitive strains or overuse, immediate rest from such activities is very important. Ice and a compression bandage may help to minimize acute inflammation. A tennis elbow strap is always helpful both at the acute and chronic stage to reduce muscle bulk expansion, hence reducing tension to the tendon origin when using the forearm and hand. Gentle elbow and wrist movements and forearm extensor muscle stretch short of pain should be encouraged immediately to prevent scar tissue formation. As the acute condition settles, gentle and progressively stronger and deeper friction massage could be given to the tendon and the muscle areas to minimize tension and adhesions. Forearm flexor muscle stretches may also be added to minimize tension against the extensors. Specific manipulative techniques applied to the related joints will help minimizing stress to the tendon. Strengthening exercises could subsequently be added but only after the condition is stabilized. Advice must be given so the patient understands the causes of the problem and modifies the activities of daily living accordingly. Prognosis could still be good if the patient follows instructions and is treated early. Unfortunately, this is not always the case, making surgical intervention such as injection often inevitable!
N.B. Golfer's elbow is a less common but similar condition with medial (inside) elbow pain. The treatment approach is similar as discussed above.
Luck LI
Musculoskeletal Physiotherapist
The treatment approach can be very different when treating different 'types' of 'tennis elbow'. Let's assume that we are dealing with the typical tennis elbow, tendonitis (inflammation of the tendon) . Other than the required medications, mechanical treatment should be given as soon as possible at its acute stage. Since the cause of the injury is often due to repetitive strains or overuse, immediate rest from such activities is very important. Ice and a compression bandage may help to minimize acute inflammation. A tennis elbow strap is always helpful both at the acute and chronic stage to reduce muscle bulk expansion, hence reducing tension to the tendon origin when using the forearm and hand. Gentle elbow and wrist movements and forearm extensor muscle stretch short of pain should be encouraged immediately to prevent scar tissue formation. As the acute condition settles, gentle and progressively stronger and deeper friction massage could be given to the tendon and the muscle areas to minimize tension and adhesions. Forearm flexor muscle stretches may also be added to minimize tension against the extensors. Specific manipulative techniques applied to the related joints will help minimizing stress to the tendon. Strengthening exercises could subsequently be added but only after the condition is stabilized. Advice must be given so the patient understands the causes of the problem and modifies the activities of daily living accordingly. Prognosis could still be good if the patient follows instructions and is treated early. Unfortunately, this is not always the case, making surgical intervention such as injection often inevitable!
N.B. Golfer's elbow is a less common but similar condition with medial (inside) elbow pain. The treatment approach is similar as discussed above.
Luck LI
Musculoskeletal Physiotherapist