Pain on the outside of the elbow or Tennis Elbow, is a condition that has existed for more than 100 years.
Today, nearly half of all tennis players suffer from this disorder at some point. However, tennis players account for just five cent of patients who visit physicians with this disorder. The others have never swung a racket in their lives.
The cause of the inflammation of the tendon on the outside of the elbow is due to injury in the tendon and muscle which is attached to the bones on the outside the elbow. This may be caused by an acute injury, such as an accident, or by repetitive use over a long period of time, causing degeneration of the tendon. This includes using sports equipment that has incorrectly been designed for the individual player, incorrectly playing sports, or being involved in jobs that require frequent lifting and dragging of heavy objects, such as that of a cleaner whose daily activities include sweeping, wringing clothes, and kitchen work.
When the tendons and muscles are injured, the patient’s muscles are not at its optimal strength. Often, the torn tendons have not been given time to heal completely before they are subject to being used again. This results in repetitive tear in tendons, causing inflammation and swelling, and the repair mechanism in the body slows down by six to 12 weeks.
The inflammation of the elbow can just be a result of tendonitis but the inflammation often includes the area in the body where the muscles and tendons are attached to the bone or joint at the elbow (epicondylitis).
Signs and symptoms of tennis elbow include:
- Recurring pain on the outside of the elbow
- Pain at the back of the hand that extends to the wrist
- Pain that intensifies when lifting objects, especially when the hand is facing down while, for example, washing dishes or stir-frying food.
- Some people may experience severe pain and are unable to |completely extend their hands or brush their teeth
A diagnosis can easily be made by history and physical examination as well as from the symptoms mentioned above. However, there are some symptoms that are often mistaken for tennis elbow, such as pain in the inside of the elbow joint, also known as Golfer’s Elbow. Another condition is pain at the back of the elbow, called Bursitis, which is caused by a cyst. Since the pain is caused by an injury to the tendon in the specified area, the best treatment is to relax and stop the use of the hand that is in pain. When the pain alleviates, begin exercising your hand to strengthen the muscle. If you are required to return to work, the pain in your hand may aggravate or recur. Spend at least 5-10 minutes exercising your hand muscles before using it again.
Physicians generally prescribe anti-inflammatory medicines to patients in the first stage, when they are not experiencing great pain. If these medications are not effective in the treatment, the physicians will recommend steroid injections into the site of the inflamed tendon. This can alleviate the pain and inflammation but should not be used continuously over a long period of time, as it may cause side effects such as whitening of the skin around the injection site, fat atrophy, or rupture of the tendons.
If the above treatment is not effective, then surgery should be considered to remove the damaged tissue and to repair and tighten the tendons. As with everything, prevention is better than cure. Here are some suggestions for preventing the injury.
- Lift objects with palm facing up
- Exercise by regularly stretching your hand muscles
- Always do warm up exercises by stretching your hands before the start of any activity
- Stop engaging in any activity that causes pain in your elbow. If you must work, then do some warm up exercises to stretch your elbow muscles, at least 5-10 minutes before using your elbow and then immediately apply a cold compress after you have finished your work. Take short breaks between work.
- Use a stretchable cloth or a ready-made fabric as an elbow wrap or support. This will help reduce and protect against any force or impact with the elbow. Use this support while playing sports or lifting heavy objects.
- If your condition and pain persists for several days, consult a physician. If you allow the pain to continue and become chronic, you may lose the ability to move the elbow permanently, or the pain may be caused by other factors, such as gout, infection, inflammation or a nerve compression in the neck.
ASSOCIATE PROFESSOR CHATHCHAI POOKARNJANAMORAKOT, MD |is an orthopaedic surgeon specialising in sports medicine and arthroscopy at Samitivej Sukhumvit Hospital. Call (02) 711 8494-6