Tennis elbow


Lateral epicondylitis, known colloquially as tennis elbow is a condition where the lateral surface i.e the outer surface of the elbow on lateral epicondyle becomes tender and swollen.

It is an over-use injury commonly seen in tennis players or even sometimes in computer users because of over use of common extensor tendon which originates from the lateral epicondyle.

SIGNS AND SYMPTOMS

  • Pain
  • Tenderness
  • Gripping movements are painful
  • Morning stiffness

PATHOPHYSIOLOGY

Cyriax proposed that there are macroscopic and microscopic tears between common extensor tendon and periosteum of lateral humeral epicondyle due to repetitive overuse.The non inflammatory chronic degenerative changes of the origin of extensor carpi radialis brevis muscle. This muscle has a small origin and does transmit large forces through its tendon during repetitive grasping,

SPECIAL TEST

COZEN TEST

1)     Examiner stabilizes the involved elbow while palpating along the lateral epicondyle. With closed fist, the patient pronates and radially deviates the forearm and extends the wrist against the examiner’s resistance

2)     Examiner stabilizes involved elbow with one hand and places the palm of the other hand on the dorsal aspect of the patients hand just distal to the proximal interphalangeal joint of the third digit

In both the tests the positive sign is patient complains of pain on the lateral epicondyle.

PHYSICAL THERAPY INTERVENTION

1) Ultrasound : Has been commonly used since years as a treatment for Tennis elbow, but very few evidence support this fact.

2) Icing: Icing has been found very effective to decrease the inflammation associated with the tenis elbow. Apply ice 2 -3 times a day for 10 min.

3) Mobilization with movement: Mulligan mobilization has found to be effective. Stabilize the humerus with elbow slightly bent and pronated. Give a lateral or a medial glide( depends on which glide is painfree) holding just below the elbow. Ask patient to either make fist and relax or extend and flex the wrist 5 times. Repeat it 3-4 times.

4) Bracing: Patient can buy a tennis elbow brace which should   be worn 1-2 cm below the lateral epicondyle .

5) Taping: The therapist can give a mobilization in either lateral or medial direction depending on painfree glide and put a tape to maintain it

6) Stretches: Patient should regularly perform stretches by holding the stretch for 10 counts.Perform the stretches 5 times for 3 times a day atleast.

7) Stregthening exercises: the Eccentric strengthening exercises are found to be effective as it works on the extensors of the wrist .

                     

8) Recently theraband academy has introduced theraflex bar exercises effective to strengthen the extensors.

http://www.youtube.com/watch?feature=endscreen&v=gsKGbqA9aNo&NR=1

9) Rest is also very important avoiding activities which may put strain on the tendon.

EQUIPMENT MODIFICATION

Using the wrong tennis racquet may have been a contributing factor to your injury. Guidelines for racquet selection fornon-tournament players are provided below.

  1. Racquet material – Graphite composites are currently considered the best in terms of torsion and vibration control.
  2. Head size – A midsize racquet (95-110 square inches) is preferred. The popular oversized racquets cause problems because they make the arm susceptible to injury due to the increased torque effect of shots hit off-center.
  3. String tension – stay at the lower end of the manufacturer’s recommendation. While higher string tensions provide improved ball control, it also increases the torque and vibration experienced by the arm.
  4. Stringing material – synthetic nylon (re-string every 6 months).
  5. Grip size – A grip too large or too small lessens control and promotes excessive wrist movement. To measure an appropriate grip size for your hand see image below.

DISCLAIMER: Kindly check with your physical therapist before attempting any of the exercises.

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