tennis elbow , diagnosis ,sign and symptoms

Describe tennis elbow

Tennis elbow, also known as lateral epicondylitis, is an inflammation of the tendons that allow your wrist to bend backward away from your palm.

A tendon is a strong tissue cord that joins bones to muscles. Extensor Carpi radials brevis is the name of the tendon that tennis elbow is most likely caused by. Men and women are typically diagnosed with tennis elbow between the ages of 30 and 50.

It should be kept in mind that only 5% of persons with tennis elbow attribute their condition to playing the sport. The main cause of LET is contractile overloads that repeatedly strain the tendon close to its attachment on the humerus.

In repetitive upper extremity activity including computer use, heavy lifting, vigorous forearm pronation and supination, and repetitive vibration, it frequently happens. Despite the name, you can frequently encounter this chronic illness in various sports like

squash, badminton, baseball, swimming, and field throwing competitions. This syndrome is also frequently found in those who work in repetitive one-sided motions, such as carpenters, gardeners, electricians, and people with desk-bound employment.

It frequently happens during recurrent upper extremity activities,

such as computer use, heavy lifting, forceful forearm pronation and supination, and repetitive vibration. Contrary to its name, you can regularly find people with this chronic illness participating in sports including squash, badminton, baseball, swimming, and field throwing events. In addition, those with desk jobs, such as carpenters, gardeners, electricians, and gardeners, are typically affected by this illness because to their continuous one-sided motions at work.


In most cases, overuse leads to tennis elbow. Slowly developing symptoms are typical. Over several weeks or months, pain could worsen. Tennis elbow can manifest as:

your outer elbow may experience burning or pain, and it could radiate to your wrist (these sensations may get worse at night).

Arm ache when bending or twisting it (for instance, to turn a doorknob or open a jar).

when you stretch your arm, you feel discomfort or stiffness.

painful to the touch elbow joint that is swollen.

Weaker grasp when attempting to hold objects like a racquet, wrench, pen, or someone’s hand.

 Why does tennis elbow occur?

As the name suggests, tennis elbow is frequently brought on by the power of the tennis racket striking the ball when it is in the backhand position. You risk overusing the muscles in your forearm, which attach to the outside of your elbow.

The tendons that roll over the end of our elbows can be harmed when we do a backhand tennis stroke.

 Tennis elbow can result from:

Tennis rackets that are too short or tightly strung are used for other racquet sports, such as squash or racquetball. Heavy, wet balls are hit off centre or with weak shoulder and wrist muscles.

 Tennis elbow, however, prevents a lot of individuals from playing tennis. Any repetitive activity can contribute to the issue. Painting with a brush or roller and using a chainsaw are two more causes of tennis elbow.

• Regular use of other hand tools in a frequent manner

• The repetitive use of hands in a variety of occupations, including carpenters, musicians, dentists, and meat cutters

 Presentation in the Clinic

The extensor muscles origin on the lateral epicondyle, which can be palpated to generate pain, is the main sign of LET. The discomfort may travel up the outside of the forearm and down the upper arm, and in rare instances, it may even reach the third and fourth fingers.

The wrist extensor and posterior shoulder muscles’ flexibility and strength are frequently found to be lacking as well.

There are four stages in this injury’s development, according to Warren, depending on how severe the symptoms are.

1. Mild discomfort a few hours after the provoking activity.

2. Acute pain following the provoking activity or right after it.

3. Agony while the Provocative action leads to increased activity when it is stopped.

4. Ongoing discomfort that prevents you from doing anything.

Additionally, weak wrist extensor and posterior shoulder muscles are frequently observed to lack flexibility and strength. Patients at least report having trouble holding objects in their hands, especially with the elbow extended, or having weaker grip strength. The finger extensor and supinator muscles of the fingers are weak. The sensation of paralysis can occur in some people, although it’s uncommon.

Between two weeks and two years is the typical duration of symptoms. Without any type of treatment other than simply avoiding the uncomfortable motions, 89% of patients recover within a year (sport injuries)

 Examination Results

Ensure that the proper treatment plan is performed to speed up the healing process by conducting thorough assessments and examinations. A differential diagnosis should be ruled out as part of the assessment.

Potential results of an objective examination could be:

• Pain may spread down the forearm to the wrist and hand and may begin 24 to 72 hours after provocative exercise involving wrist extension.

• Changes in biomechanical parameters, such as using a new tennis racquet, hitting a wet ball, overtraining, using bad technique, or suffering a shoulder injury.

The objective evaluation may reveal the following:

 • Pain and point tenderness over the lateral epicondyle and/or 1-2 cm distal to epicondyle

• A lack of strength while measuring grip strength (Dynamo-meter)

• Weakness in the elbow extensors and flexors, which results in pain and/or restricted motion during passive elbow extension, wrist flexion, ulnar deviation, and pronation

 Procedures for diagnosing OF TENNIS ELBOW

A thorough history-taking process is followed by inquiries concerning the patient’s level of activity, occupational risk factors, and participation in recreational sports, use of medications, and other medical issues. Knowing what activities aggravate your symptoms and where they manifest on your arm is crucial.

The elbow’s structure and those of other joints are examined during the physical examination. Examinations are also done on the skin, muscles, bones, and nerves. ECRB or common extensor origin soreness supports the diagnosis of LET. The therapist or physiotherapist ought to be able to imitate the usual pain using the following techniques:

 • A tennis elbow dynamometer and a patient-rated tennis elbow evaluation questionnaire are available to assess the condition’s severity (PrTEEQ).  Grip power is determined with a dynamometer. A 15-item survey called the PrTEEQ was created to assess patients with lateral epicondylitis’s forearm discomfort and level of functional impairment. On a scale of 0 to 10, which has two subscales, patients are asked to score their tennis elbow discomfort and disability. Both the pain and function subscales go from 0 (no pain) to 10 (the greatest pain imaginable), respectively.

• Cozen test

it is sometimes referred to as the resisted wrist extension test or Cozen’s test. In flexion at 90 degrees, the elbow is stabilised. With their other hand, the therapist places the patient’s elbow while palpating the lateral epicondyle.

 Pronation of the forearm and deviation of the hand. The patient is thereafter instructed to resist extending their wrist. If the patient feels acute pain above the lateral epicondyle that comes on suddenly and sharply, the test is positive. Very sensitive despite having inadequate specificity to rule out other potential diagnoses has been discovered with positive data pointing to the existence of LET.

• Chair test:

With their elbows completely extended, the patient grasps the back of the chair from behind and tries to lift it by pinching it with their thumb, index, and long fingers. Pain at the lateral epicondyle indicates a positive test result.

 The patient is seated while performing the Mill’s Test, with the elbow extended and the upper extremity relaxed at the side. A passive wrist flexion and pronation stretch is performed by the examiner. For LET, pain at the wrist extensors’ proximal musculotendinous junction or lateral epicondyle is a good symptom.

• The Maudsley test: involves the examiner palpating the lateral epicondyle as he or she resists extending the third digit of the hand. Pain above the lateral epicondyle during a test is a sign of success. The inclusion of the LET diagnosis but confident exclusion of it has been shown to have 88% sensitivity.

The test with the coffee cup.

As an example, picking up a milk bottle or a cup of coffee that is already full would be considered a distinct activity during the test. The patient is prompted to rate their level of pain.

On a scale from 0 to 10.

 Medical Management

Medical Care without Surgery

The primary method of managing LET is nonoperative medical care. The fundamental foundation of it is built on two ideas: reducing inflammation and easing pain. It might contain:

 NSAIDs may be used in acute cases for short-term pain relief and inflammation control. Common recommendations for pain relief include rest and activity modification.  Via lowering the degree of chemical activity and by vasoconstriction, the use of ice three times a day for 15 minutes is also advised for minimising the inflammatory response and oedema. When the wrist or fingers are swollen, it is also a sign that the extremities should be elevated.

• Another method for lessening the discomfort of the LET contraction is an elbow counterforce brace.  In the capacity of a forearm orthosis, it might serve as a secondary place for a muscle to attach and ease pressure on the insertion at the lateral epicondyle. On the forearm, the brace is wrapped.

 When the patient extends their wrists, the wrist extensors are partially contracted (just below the head of the radius) because the ligament is sufficiently tight. Subperiosteally at the extensor brevis origin, injections may be administered. There are reports of an immediate and favourable reaction from these injections. Increased discomfort, however, could be felt over the first 24 to 28 hours. The average recovery time after a steroid injection is 1-2 weeks, and it shouldn’t be done more than twice.

According to reports, steroid and hyaluronic acid injections only last around three months before they lose their effectiveness, meaning the patient must keep up the exercise regimen. The preparation and effectiveness of injections with plateletrich plasma and autologous blood differ. In the intermediate or long term, there hasn’t been any conclusive evidence that injections are superior to a placebo; therefore, it is important to take into account the possibility of recurrence.

 Surgical intervention

Surgery may be necessary if non-operative treatment is ineffective for more than six months.  The majority of surgical treatments for this issue involve cutting away the damaged muscle and reattaching the healthy muscle to the bone. Numerous considerations will determine the best surgical strategy. These include the severity of the injuries, overall health, and individual requirements.

Open surgery

 This method of LET repair is the most typical. Over the elbow, there must be an incision made. Typically, open surgery is done as an outpatient procedure. Rarely does it necessitate an overnight hospital stay.

• Arthroscopy surgery

Small tools and incisions can also be used to repair LET. This is an outpatient or same-day operation, similar to open surgery.

Management of Physiotherapy

Methods for managing LET with general physiotherapy include:

• Information or suggestions for modifying activity or pain management

• Treatment modalities include ice, massage, ultrasound, transcutaneous electrical nerve stimulation (TENS), laser, and shockwave therapy.

Strengthening and stretching exercises under supervision Mulligan’s manual therapy, mobilisation with movement

• Sport- and occupation-specific rehabilitation

Support for Physiotherapy

Evidence for the best application of physiotherapy techniques in the treatment of LET is currently limited.  As a result, both clinicians and patients may choose to use a different set of relevant procedures.

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