“Madam A, you are suffering from a tennis elbow.”
“But I have never played tennis in my life. I am not active in sports.”
“You don’t have to be an athlete to get tennis elbow. Housewives often get it as they are taking care of most of the household chores such as washing dishes, cooking, mopping, and etc.”
“So what is this all about?”
Tennis elbow is also known as lateral epicondylitis. It is the most common overuse syndrome in the elbow. The pain from tennis elbow is mainly from the injured tendon on the outer part of the elbow. Tendons are strong tissue bands that connect muscles to bones. Tendons can become inflamed and degenerate when they are repeatedly stressed or overused. This will be resulting in a painful condition called tendinopathy, the medical term for a disorder of tendon.
What are the common signs and symptoms?
(a) Pain in the region of the bony knob on the outer elbow (lateral epicondyle) extending to the dorsum of the forearm.
(b) Tenderness upon palpation on the bony knob on the outer elbow.
(c) Weakness in grip strength.
(d) Difficulty in carrying objects in hand, especially with the elbow straightening.
What are the risk factors?
(a) Hypercholesterolemia
(b) Diabetes mellitus
(c) Hormonal imbalances
(d) Older age
(e) Genetics
These systemic risk factors are thought to reduce the tendon capacity to manage load such that routine activities of daily living may be enough to trigger a pathological cycle.
Besides, workers in manual occupations which involving repetitive arm and wrist movements are at increased risk of developing tennis elbow. For example:
(a) Painter
(b) Plumber
(c) Butcher
(d) Dentist
(e) Chef
(f) Office worker
Tennis, squash, and badminton players, golfer or gym goers are also at higher risk of suffering this condition as those activities involving repetitive wrist extension or if they have improper hitting techniques or improper training forms.
How is it diagnosed?
The diagnosis is made based on clinical history and physical examination.
Imaging studies, such as ultrasound and magnetic resonance imaging (MRI), have high sensitivity but lower specificity in detecting tennis elbow. Structural changes on imaging are present in approximately 50% of healthy, asymptomatic age-matched and gender-matched individuals, indicating that caution must be applied in interpreting the findings.
The specific clinical test for tennis elbow has the aim of reproducing the pain experienced by the client. The test is known as Cozen’s test.
(a) It is done with the affected elbow bent at 90˚ and with the palm is facing downward.
(b) The client is asked to perform active wrist extension against the resistance imposed by the physiotherapist.
(c) The test result will be positive when the client reports pain in the region of the bony knob on the outer elbow.
The alternative test is known as Mill’s test.
(a) It is performed with the client’s affected elbow is straighten.
(b) The physiotherapist then turns the forearm to the position where the palm is facing downward and bends the wrist downward.
(c) The test is positive if the client feels pain in the region of the bony knob on the outer elbow.
References:
1. Marcio Cohen and Geraldo da Rocha Motta Filho. 2012. Lateral Epicondylitis of The Elbow. Rev Bras Ortop 47(4): 414-20.
2. Leanne M Bisset and Bill Vicenzino. 2015. Physiotherapy Management of Lateral Epicondylalgia. Journal of Physiotherapy 61: 174–181.
3. Joseph M. Day, Ann M. Lucado and Timothy L. Uhl. 2019. A Comprehensive Rehabilitation Program for Treating Lateral Elbow Tendinopathy. The International Journal of Sports Physical Therapy 14(5): 818-834.