Relief from Tennis Elbow
Causes and Treatment of Lateral Epicondylitis
Tennis elbow is probably the most common overuse injury to occur at the elbow. Any sport that requires repeated use of the arm can produce the condition as can other activities like DIY – using a screwdriver for example. There are a number of different types of treatment and their effectiveness is variable.
Symptoms
The chief symptom is pain at the elbow on use of the hand or wrist. In the acute stage simply gripping a cup can give rise to sharp pain which is most often felt at the lateral epicondyle of the affected elbow. This is the outer bony protuberance of the elbow when the arms are by the side with the palms facing forwards. Pain can also occur in the muscles of the outer forearm.
The test for tennis elbow involves holding the arm straight with the wrist bent backwards. When an attempt is made to straighten the wrist against resistance, a sharp pain is felt at the lateral epicondyle.
Pathology
The other name for tennis elbow is lateral epicondylitis which suggests that inflammation is part of the process. However there is some doubt about this. It's more probable that the condition involves micro-tears in the tendon and subsequent scar tissue formation. If inflammation is a factor it is likely to be only in the early stages of the disorder.
Treatment
When there is a multitude of treatments for a condition there's a good chance that none is highly satisfactory. This is the case with tennis elbow where response to all modalities of treatment is variable.
- Rest: This is normally the first thing suggested. If you have a job that involves use of your hands this simple advice could be quite difficult to follow. However if it is possible, it can be effective.
- Orthotics: Splints and bands that support the forearm muscles and elbow.
- Deep tissue massage: Usually incorporates the use of trigger points.
- Acupuncture: Use of needles or laser.
- Shockwave therapy. Sound waves are applied to the affected area.
- Non-steroidal anti-inflammatory medication: This can be given orally or as a cream or gel to be rubbed into the elbow. Probably more effective if used in the early stages.
- Steroid Injections: A common form of treatment, especially when more conservative methods have failed.
- Surgery: Last ditch treatment, resorted to when the condition is very painful or debilitating and steroids have failed.
How Well do the Treatments Work?
As mentioned earlier the response varies greatly. In an effort to determine the most effective treatments, a number of reviews on the various methods have been carried out for the Cochrane Collaboration. With regard to orthotics, deep tissue massage and surgery, the jury is still out. Although some sufferers seem to get help, the Cochrane reviewers found too few well-conducted controlled trials to be certain of benefit.
Acupuncture, with needles, not laser, and shock wave therapy were found to give some relief, at least in the short term. Again the shortage of good studies prevented any conclusions on long term effectiveness.
Steroid injection was found to give the most consistent benefit in the trials reviewed.
This article is for information only. If you have any concerns you should consult the appropriate health professional
Resources
C T Lorenzo, Lateral Epicondylitis, 2007
