What is Epicondylitis/Tennis Elbow? 

The elbow joint is comprised of three bones: the humerus, the radius, and the ulna.  The muscles that move the wrist attach to bony outgrowths on both sides of the humerus called epicondyles.  These epicondyles are attachment points for the muscles that create motion at the wrist.  The muscles that cause the wrist to extend attach to the lateral epicondyle on the outside of the elbow, while the muscles that cause the wrist to flex attach to the medial epicondyle on the inside of the elbow. When these muscles become overused, the points that they attach are painful 

Symptoms:

Patients suffering from Epicondylitis most commonly experience a pain on one side of the elbow that is typically developes over time.  Depending on which type of epicondylitis you have, pain will be located on the lateral portion (thumb side) or medial portion (pinky side) of the elbow.  This pain may stay only around the elbow or it may travel down the arm and into the fingers.  Muscle weakness and difficulty grasping objects are other common symptoms. 

Causes Of Epicondylitis:

Although it has been previously been thought epicondylitis is caused by an inflammatory process, it is now understood that the pain is caused by a lack of blood supply due to damage of small blood vessels.  When the tendons of the muscles become damaged due to excessive use, the decreased blood flow does not allow for proper healing and chronic pain can develop. 

Diagnosis:

 Lateral Epicondylitis:  

• Pain with palpation of the outside of the elbow.  
• Pain and/or weakness with resisted wrist extension.  
• Recreate pain with passive elbow extension and wrist flexion

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Medial Epicondylitis:  

• Pain with palpation of the inside of the elbow.  
• Pain and/or weakness with resisted wrist flexion.  
• Recreate pain with passive elbow extension and wrist extension  

Treatment:

Epicondylitis can be self limiting, however this process can be slow.  To speed healing and for optimum results, a combination of physical therapy modalities, such as electrical stimulation and ultrasound, and rehab exercises can be beneficial.  Stretching and strengthening of the tendons can help restore normal blood circulation and restore normal function to the damaged structures.  Eccentric exercises have been shown to be superior in the correction of tendinosis.

Home Care:

When caring for non-complicated epicondylitis at home, the PRICE protocol has been demonstrated to be an effective measure in decreasing pain and swelling. Individuals undergoing home care for soft tissue injuries such as ankle sprains should perform the PRICE protocol immediately after injury and continue for the first 24 hours. RICE stands for Rest, Ice, Compression & Elevation.

Rest: 

Rest from the aggravating activity is an essential component to the healing process.  This does not, however, mean that all activity should cease.  Therapeutic exercise can be helpful in correcting the underlying tendinosis of the condition.

Ice:

Although ice is a great tool when used to decrease the pain associated with an acute injury, it can actually delay the healing process. subsequently, icing should not be continued more than 24-48 hours following the injury. it is recommended that ice be applied to the injured elbow for 10 minutes follow by at least 20 minute period of no ice repeated throughout the first 24 hours. Ice should not be applied directly to the skin and should not be left in place longer than 10 minutes to avoid cold related injury.

Compression:

Although some swelling is inevitable, too much swelling results in significant loss of function, excessive pain and eventual slowing of blood flow through vessel restriction. The addition of a compression wrap to the elbow may assist in the reduction of swelling and prevent it from returning after it has subsided.

Elevation:

Elevating the injured area above heart level can allow gravity to assist in the removal of swelling.  This encourages metabolic waste to leave the site of injury and allows new blood to profuse the area to speed healing.

Risk Factors & Prevention:

Repetitive Motion:

Most epicondylitis conditions develop due to continuous or repetitive motions.  Chronic bouts of wrist flexion or extension can damage the corresponding tendons predispose one to developing tendinosis.    

Prevention:

In most cases a combination of properly preparing for activity, as well as stretching and strengthening exercises, will be enough to keep your elbows from being injured. For athletes, it is important to use proper form when playing and practicing to decrease the risk of developing epicondylitis.