“Madam, you are suffering from a tennis elbow”. Pat comes the answer: “But Doc, I have never played tennis in my life?”
Tennis elbow is a fairly common condition that affects the elbow in not only players and athletes but also in non-athletes as well. So why is it known as tennis elbow? What is this all about? And how can we help sort this problem out? These are some of the issues that I would answer in this column.
Our elbow serves as an intermediary link between the shoulder and the wrist. As a result, any positioning of the arm or any transfer of weight from the shoulder to the hand and visa versa is linked through the elbow. The muscles that move the elbow mainly cause two functions:
- They either bend the elbow or flex the elbow and
- They straighten the elbow or extend the elbow.
Muscles around the elbow will also help in moving the fingers and wrist upwards and downwards as well. It is this interplay of all the muscles that causes the elbow to be an important link hinge joint between the shoulder and the wrist.
Tennis elbow usually is known as Extensor Epicondylitis. What that essentially implies is that the extensor muscles, which means the muscles that would move the wrist upwards or extend the wrist upwards, are inflamed at the site of the outer corner (lateral epicondyle) of the elbow as a result of an injury to the same. The resulting inflammation in that area gives a rise to a typical tennis elbow pain. The reason it is called tennis elbow is that it was first described in a sportsman who sustained this injury after a mismatched winner that he played. He felt a sharp pain on the outer side of the elbow, which then got referred to the synonymous tennis elbow.
This common problem usually results as a cause of two mechanisms. The less common one is that of an acute injury in which there is a sudden sharp burst of energy to the muscle which causes a partial tear and thus results in the painful episode. The second or the more common modality is that of a chronic overuse micro trauma in which there is a constant injury which results in the muscle tendon bone junction getting overload, over-fatigue and resultant over-failure. This particular mode of injury is more common especially with housewives, in day-to-day activities such as opening shutters of a shop, lifting weights from one position to another such as on a shop floor, trying to open a relatively less oiled stiff lock or handle and so on so forth. The housewife will typically face it especially when she is trying and lift up a utensil filled with milk with a pair of pliers or she is trying to wring out the water from a towel or even when she is putting on a bed sheet and shaking it violently before laying it on the bed.
Typically, there is pain around the outside of the elbow and this pain is increased or pronounced when the patient is asked to do a violent muscle contraction of the involved muscle against resistance. The movements in the elbow are generally completely well-preserved and there is no gross visible swelling or deformity around the elbow. X-rays are usually negative and this problem can be picked up very well on either ultrasonography or an MRI scan.
As soon as this problem is diagnosed, the next stage will be moving onto a set and effective treatment plan to help relieve the symptoms of tennis elbow. This treatment should be able to stop the pain that you are experiencing in and around your elbow. Some people may find their relief in CBD, as this has been known to help treat any chronic pain. This can be taken in pills, oil, or by applying some pain cream to the affected area, like the cream you can find at somewhere similar to Every Day Optimal CBD, (https://www.everydayoptimalcbd.com/product/cbd-pain-cream/). Others may be able to find something that is just as effective through over the counter medication. But you should always consult your doctor for a long term treatment plan.
The treatment of this problem is largely non-surgical. Physical therapy in form of stretching out the stiff joint, strengthening the weak muscle and releasing the tight muscle through modalities by opting to find a dry needling provider or deep pressure manual therapy are very useful. Sometimes a short course of local ultrasonic treatment may be given to soften the stiffness and adhesions around the elbow joint. Strengthening exercises are gradually instituted to bring back strength to the weakened muscles, which usually result in the resolution of all the symptoms and all the problems. To prevent supramaximal contraction of the muscles, many a times I prefer to give patients a small elbow band which, exactly does not sit at the elbow joint, but slightly below it. The purpose of the band is to provide restriction to supramaximal contraction of the muscle, which may further aggravate the problem. This tennis elbow band is to be worn typically through out the day especially while doing activities.
When these modalities fail, one would then resort to invasive treatment. Platelet rich plasma injections have come in as a boon for this particular problem. The injection of patient’s own plasma, which is rich in platelets,releases a sudden surge of growth factors into the affected area. These growth factors then become extremely useful to heal the torn tissue, which then would rejuvenate and regenerate to give a solid strong muscle. In patients who have sustained an acute tear of the muscle, or in whom these modalities have not worked at all, surgery may be indicated. Surgical treatment usually is either open surgery or arthroscopic surgery to release the tight, stiff, inelastic, painful scar tissue and to re-approximate muscle back to the bone.
So friends, tennis elbow in my clinical practice is hardly because of playing tennis. The typical presentation is the middle-aged housewife who has sustained this particular problem due of a lot of work in the kitchen. So I feel it will be apt to name this a “cooking elbow”. The next common modality of this injury that I see in clinical practice is the enthusiastic gym going adult who is lifting heavy weights and then gets this type of a problem as a result of a sudden jerk. Prevention is the key and doing a good regular stretching programme would be the best way to avoid this in such situations.
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