Conditions and procedures

Tennis elbow or lateral epicondylitis is overuse injury to the common extensor tendon of the elbow which leads to pain on the outer aspect of the elbow. It predominantly occurs in the dominant arm in patients in the 40-60 years age group.

●Improper use of equipment
●Repetitive wrist extension and flexion activities
●Tennis and other racquet sports
●Work related injuries

●Slow onset of pain which worsens gradually
●In severe form, even holding things as light as a coffee cup can be painful
●In advanced stages, the pain is present even at rest and during nights
●Occasional numbness and tingling
●Associated faulty equipment and technique in racquet sports
●Poor general conditioning

●Nerve entrapments in the forearm
●Osteoarthritis of the elbow joint
●Referred pain from the spine
●Bone changes in the elbow joint
●Stress fracture in the elbow bones
●Ligament injury in the elbow joint

●Too much of ball hitting
●Hitting the balls in to the wind
●Use of wet and hard balls
●Improper racquet - weight and size
●Improper backhand technique with extreme wrist flexion while performing the backhand
●Single handed backhand, relying on forest muscles( kinetic chain deficits)

Tennis elbow is a clinical diagnosis. Commonly, the pain is associated with tenderness on palpation of the outer aspect of the elbow. The pain increases on resisted extension of the wrist and the middle finger. There may be associated swelling and sensitivity of the skin. In throwing sports, the pain is generally in the deceleration phase of throwing. Associated restriction in shoulder and upper spine movements is not an uncommon finding.

The tendon changes can be easily seen on the Ultrasound scan which shows thickening, collagen disruption, partial or full thickness tears. X-ray and other investigations help to rule out the differential diagnosis.

●Patient education and ruling out the differential diagnosis
●Activity modification
●Correcting equipment and technique errors
●Pain medications and topical creams/GTN patches
●Counter pressure brace
●Progressive rehabilitation and load management with physical therapy
●In resistant cases, Biological therapies show good results especially if there is a partial tear
●Cortisone injections provide only short term relief but are associated with side effects
●Surgery is limited to very resistant cases but the outcome can be unpredictable