Common Tennis Injuries
Tennis Elbow (Lateral Epicondylitis)
What is Tennis Elbow?
Tennis elbow (lateral epicondylitis) is an overuse injury affecting the tendons in your forearm muscles that are attached to the outside of your elbow (lateral epicondyle). This condition is not just limited to tennis or racket sports, but can happen to anyone who stresses the wrist extensors and supinator muscles of their forearm.
In most cases, mild pain or a burning sensation starts on the outer part of the elbow. It may also lead to a weaker grip and even pain at night. Symptoms may worsen with forearm activity such as holding a racket, turning a wrench, or wringing out a wet towel.
There are small tears over the extensor carpi radialis brevis (ECRB) muscle which helps to stabilise the wrist when the elbow is straight. Microscopic tears form in the tendon of the ECRB as it is attached to the lateral epicondyle.
What can happen if Tennis Elbow is left untreated?
Neglected tennis elbow may lead to mild pain, which can degenerate into a severe and debilitating injury. This may be accompanied by weakness during grip activities or a loss of function. Painters, cooks, and plumbers are prone to this injury due to the nature of their jobs and the repetitive weightlifting and forearm twisting activities that they perform daily.
Diagnosis of Tennis Elbow
Your doctor may recommend some imaging to diagnose the injury and exclude other injuries around the elbow.
An X-ray will give your doctor information about the bone structure of the elbow as well as to exclude arthritis.
An MRI scan will provide detailed images of the bones and soft tissue around the elbow, including possible tears of the ECRB which may be causing the symptoms on the outside of the elbow.
Other differential diagnoses such a cubital tunnel syndrome of the elbow may require other imaging modalities such as an electromyography (EMG). This may be done after your doctor clinically assess your elbow and symptoms.
It is important to diagnose this injury once you experience pain on the outside of your elbow. Getting enough rest from the activity also helps to protect the elbow from further damage.
Reduce swelling and inflammation of the area by applying ice for 30 minutes every 3 to 4 hours for a few days or until the pain is gone.
Anti-inflammatory medication can also help to reduce the pain and swelling, thus accelerating your recovery.
Consider wearing a forearm muscle splint, or brace, for either golfers’ or tennis elbow. This brace is worn about two finger-breaths below the elbow crease and works by taking the strain off the affected tendon. It is recommended to wear the brace even when you are not playing tennis, and for a period of about 4 to 6 weeks.
Physical therapy or physiotherapy will help to strengthen the muscles of the forearm and stretch out tight muscles. Treatment modalities such as ultrasound, massage, ice and muscle simulating techniques may accelerate your healing.
Injections around the painful area may help to alleviate the pain and reduce swelling. This may be in the form of a combined injection containing a local anaesthetic or steroid. Platelet-rich plasma (PRP) is an effective pain-relieving biological treatment to facilitate soft tissue healing that has also been shown to improve symptoms.
Extracorporeal shockwave therapy uses sound waves to promote healing of microscopic tears of the ECRB tendon.
Open or arthroscopic surgical repair of the torn ECRB tendon may be indicated in recalcitrant cases. These surgeries are rarely needed with adequate rest and non-surgical treatment.
Your recovery depends on many factors, such severity of the injury and the type of aggravating physical activities that one is involved in. It often takes about 4 to 6 weeks for tennis elbows to recover.
What to do now while waiting for diagnosis/treatment?
Refrain from strenuous forearm physical activities for a week or two once you start experiencing symptoms. Application of ice and consumption of anti-inflammatory medication will help with the pain and burning sensation associated with tennis elbow.
It is important to not rush your recovery. This may result in aggravation of your injury and delaying your return to sports.
How to prevent Tennis Elbow?
There are several things you can do to reduce the stress on your forearm muscles and prevent getting a tennis elbow:
If you clutch or grip your racket too hard, you will undoubtedly stress the muscles of your forearm and may develop pain on the inside or outside of your elbow, or both. Relax your grip and reduce the tempo of your swing.
Consider the size of the grips of your racket. If the grip is too small, you will end up unnecessarily stressing the muscles in your forearm. Reduce the stress on your forearm muscle by using a larger grip for your racket.
Some tennis players are guilty of never changing the grip for our rackets. Each grip has a specific firmness and texture that would suit your individual game. Grips that are worn out with little texture will make players use excessive hand pressure to create a confident grip on their rackets. This lack of hand traction and gripping confidence will overstrain your forearm muscles, thus leading to pain around the elbow.
Source: Mayo Clinic