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Lateral epicondylitis is an overuse or repetitive stress injury. Its primary cause is repeated contraction of your forearm extensor and flexor muscles. These muscles play an important role in your ability to straighten or raise your hand as well as raise your wrist. If you perform those movements repeatedly over time, you may develop small ruptures in the tendons that connect these forearm muscles to the bone on the outside of your elbow. The result is tennis elbow.
The types of repetitive movements that can bring the condition on include routine things like shaking hands, holding a cup, etc. However, they can also include the movements involved in plumbing work, painting, gardening, cooking or using a computer. In general, activities that require precise wrist and hand movements (cutting up meat or operating a computer mouse) can bring on tennis elbow.
The factors that place you more at risk for developing the condition include:
Tennis elbow pain usually occurs primarily around the bony prominence (bump) on the outside of the elbow. That pain comes from the inflamed condition of your forearm tendons and the fact that they attach to that bump. The pain may start there but it frequently radiates to your forearm and wrist.
Another tennis elbow symptom is difficulty performing everyday tasks due to a lack of gripping strength. These tasks may include (for example) shaking hands, gripping an object firmly, holding a cup or even turning a doorknob.
Tennis elbow symptoms may sometimes resemble those of other overuse injuries, particularly golfers elbow. To be sure that your symptoms are indeed those of tennis elbow, you may need to visit your doctor for an examination.
Your doctor will usually be able to diagnose your tennis elbow via a physical exam and review of your medical history. If he or she suspects that your pain may have other causes, he may request imaging tests such as an X-Ray or ultrasound exam.
If the doctor confirms that your symptoms are indeed those of tennis elbow, treatment may involve one or more of the following steps. We suggest that you initially try a conservative tennis elbow treatment from the list below. If this is unsuccessful, you may wish to discuss the more radical treatments with your doctor.
As with any overuse injury, rest is an important part of the recovery process. If your injury is the result of an activity that you can cease doing for a while, such as a recreational sport or hobby, this may be feasible. However, if the injury derives from occupational activity, you may not be in a position to suspend these activities for a period. In this case, other measures may be necessary.
Your doctor may refer you to a physical therapist. The therapist can introduce you to exercises that will gently stretch and gradually stretch your forearm muscles. For example, these may include raising your wrist and then slowly lowering it. We will consider tennis elbow exercises in more detail in a separate article.
In conjunction with the physical therapy exercises we have mentioned above, your physical therapist can recommend that you wear a tennis elbow brace to ease the pain. These braces will reduce the forces travelling up your forearm muscles to reach the tendons attaching to your elbow. This will give those tendons an opportunity to rest and recover.
Tennis elbow braces come in several different designs. However, they are all designed to apply pressure to your injured elbow tendon and absorb some of the vibrations and forces that are causing injury. The various designs include straps (like the one pictured at right) and sleeves that cover the forearm area as well as the elbow. In some cases, there may be an adjustable pad under the brace. This is an individual customization feature that allows you to adjust the area to which the brace applies pressure.
Because of the wide variety of designs, it is important to take the nature of your tennis elbow injury into account when choosing a design.
If the conservative treatment options listed above do not work, your doctor may suggest some more invasive approaches. These may include plasma or botox injections into the injured tendon. Alternatively, he or she may recommend surgery to remove the damaged tendon areas. The doctor can perform this surgery either via one large incision or via several small ones. In general, you should give the conservative treatment options 6-12 months to work before considering more aggressive approaches.
Another invasive procedure you can consider to treat persistent tennis elbow is ultrasonic tenetomy, or a TENEX procedure. A specialist will insert a needle into the injured portion of the tendon. The needle will be under the control of ultrasonic energy. This energy will then cause the needle to vibrate at high speed to liquefy the damaged tissue. Once this is done, the liquefied tissue is suctioned out of your elbow.
The invasive approaches mentioned above involve removal of injured tissues. As a result, physical therapy exercises to restore elbow strength and function will be extremely important once you have completed surgery or injections to correct your tennis elbow.
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