October 30, 2018
Tennis Elbow | Common Extensor Tendinopathy | Lateral Epicondylagia | Lateral Epicondylitis | Common Extensor Tendinosis
Tennis elbow or common extensor tendinopathy is termed as a chronic overuse condition. It is likely secondary to continued microtrauma coupled with an incomplete or failed healing response –therefore the collagen and elastin fibers of the tendon become damaged - this can also be referred to as tendinosis (Erickson & Hall, 2015).. A good image for this is a rope which has started to fray. It is not completely severed but it is not as strong and robust as it should be. This fraying and disruption of the tendon fibres causes pain at the tendon as well as muscle spasm around the elbow and pain into the forearm. The most common location of injury is within the common extensor tendon, involving the extensor carpi radialis brevis (ECRB ) and Extensor radialis longus (ECRL) extensor carpi ulnaris can also be involved (Erickson & Hall, 2015). Although there are identified anatomical changes more recent studies suggest this is not always the reason for pain and that pain can be more related to neurogenic changes (nerve related).
Tennis Elbow or common extensor tendinopathy is the most common clinical reason for lateral elbow pain we see. Whilst most cases settle relatively quickly and are usually self limiting, some cases can turn chronic and lead to substantial time away from work and sport (Erickson & Hall, 2015). Lateral elbow pain effects 1-3% of the general population, however, will effect 40% of the population through the lifespan (Bisset & Vicenzino, 2015). It more commonly presents in 30 – 60 year olds but is not limited to this age group (Bisset & Vicenzino, 2015).
Patients with a common extensor tendinopathy usually report a gradual onset of pain usually in the dominant arm. Pain can radiate down the forearm. Often a history of repetitive use precedes this - for example -repetitive gripping and lifting activities such as assembly line work or manual labor such as carpentry- sports involving racquets can be a cause (Erickson & Hall, 2015). Office workers also frequently report lateral elbow pain particularly in the hand which uses the mouse. Patients frequently report pain on gripping, opening jars or door handles and are usually tender to pressure on the outside region of the elbow. It is not uncommon for patients to have previous history of shoulder or rotator cuff injury or to have it concurrently (Bisset & Vicenzino, 2015).
Anti-inflammatory medication has been reported to have low level evidence to reduce acute inflammatory process in reactive or acute tendons, however, are not as effective in chronic long term injuries (Erickson & Hall, 2015). Physiotherapy modalities incorporating targeted manual therapy (joint mobilisation, neural glides and soft tissue techniques) dry needling and specific graduated tendon loading program have been shown to be effective in reducing pain and disability (Bisset & Vicenzino, 2015; Erickson & Hall, 2015). Tennis elbow braces can also be effective in reducing symptomatic pain and disability by offloading the affected area. Injection therapies such as corticosteroid injections, prolotherapy injections, autologous blood injections, platelet rich plasma injections and surgical interventions that can also be considered on a case by case basis and with relevant doctors and specialists consulted.
The amount of time that the tendon takes to heal or settle depends on how severe the injury is and how long it has been an issue. Very mild cases can be mostly healed in 4-6 weeks but most cases will take around 8-12 weeks to heal, however, more chronic cases can take 12-24 months for gradual improvement.
If you think you may have Tennis Elbow get in touch with Inertia Health Group to book an appointment to discuss treatment.
Bisset, L. M., & Vicenzino, B. (2015). Physiotherapy management of lateral epicondylalgia. Journal of Physiotherapy, 61(4), 174-181. doi:10.1016/j.jphys.2015.07.015
Erickson, J. L., & Hall, M. M. (2015). Evidence-based treatment of common extensor tendinopathy. Current Physical Medicine and Rehabilitation Reports, 3(1), 50-59. doi:10.1007/s40141-014-0070-1