Tennis elbow causes pain when you're carrying heavy items.
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Elbow pain can significantly affect your ability to perform daily tasks. Lateral epicondylitis -- more commonly called tennis elbow -- is a frequent cause of elbow pain. This condition is caused by irritation of tendons that straighten the fingers and bend the wrist backward. Severe cases of tennis elbow that do not heal with conservative treatment may require surgery.
Muscles that straighten the fingers and bend the wrist backward are collectively called the extensors. These muscles join to form the common extensor tendon, attaching to the lateral epicondyle on the outside of the elbow. Tennis elbow causes pain on or just below this bone.
Tennis elbow was traditionally thought to be caused by inflammation of the common extensor tendon. However, according to a 2008 review published in "Clinical Orthopaedics and Related Research," studies have not found inflammation to be present in overuse injuries such as tennis elbow. Instead, microtears in the tendon are thought to be the underlying cause of this condition. Damage occurs over time with frequent use of the extensor muscles combined with a forceful hand grip.
Tennis elbow is usually diagnosed by physical examination. People with this condition report pain with daily activities that require repetitive wrist movements and gripping. Pain is provoked with pressure on the lateral epicondyle, the pointy bone on the outside of the elbow. Resisted wrist extension -- pressure applied to the back of the hand while the wrist is held in a backward position -- also causes pain and sometimes weakness.
The "chair test" is often used to diagnosis tennis elbow. The patient is told to grasp and lift the back of the chair with elbows straight and palms down. Pain on the outside of the elbow is a positive finding. X-rays and MRI are sometimes used to rule out other causes of elbow pain, such as arthritis.
Conservative treatment for tennis elbow often includes oral anti-inflammatory medication, topical gel and cortisone injections. Diclofenac sodium (Voltaren) is sometimes prescribed in pill form or as a topical gel to treat tennis elbow. Despite research findings that indicate inflammation is not present, these medications have been shown to decrease tennis elbow symptoms. According to a study published in 2013 by the "Journal of Orthopaedic Science," approximately 95 percent of cases of lateral epicondylitis heal spontaneously or with nonsurgical treatment. A splint is sometimes used during daily activities to prevent wrist movement. A counterforce strap, which wraps around the forearm approximately 2 inches below the elbow joint, is worn to reduce force on the common extensor tendon during the day.
Physical therapy is prescribed for conservative treatment of tennis elbow. Heat, ultrasound, electrical stimulation and ice are used to reduce pain and promote healing. Forearm stretches are performed several times each day -- held for 20 to 30 seconds with three repetitions -- to reduce tension in the wrist extensor muscles. Exercises improve strength of the wrist and forearm as well as grip.
Tennis Elbow Release
The surgical procedure used to treat lateral epicondylitis is called a tennis elbow release. It is indicated for the approximately 5 percent of people with this disorder who do not improve with nonsurgical treatment, according to the authors of the 2013 "Journal of Orthopaedic Science" study. A small incision in made on the outside of the elbow, and muscles are moved to expose the extensor tendon. The tendon is cut at the lateral epicondyle and split with a scalpel. Scar tissue is removed, as are any bone spurs that may be present. The loose end of the tendon is sewn to nearby connective tissue, and the incision is stitched closed. This procedure releases tension on the common extensor tendon.
Instructions after tennis elbow surgery vary by surgeon, although most follow similar principles. A splint is worn for approximately one week after surgery to rest the elbow. Physical therapy treatments, including heat, ultrasound and electrical stimulation, are performed to decrease pain and postoperative swelling. The splint is removed and elbow bending and straightening are performed during the second week. Grip and wrist strengthening exercises progress slowly over the first six weeks after surgery, when normal activities can be resumed.