Lateral Epicondylitis

What is a lateral epicondylitis injury?  

Lateral epicondylitis, commonly known as tennis elbow, is a painful condition involving the tendons that attach to the bone on the outside (lateral) part of the elbow. Tendons anchor the muscle to bone. The muscle involved in this condition, the extensor carpi radialis brevis, helps to extend and stabilize the wrist. With lateral epicondylitis, there is degeneration of the tendon’s attachment, weakening the anchor site and placing greater stress on the area.

How does it occur?  Lateral Epicondylitis can be caused by:

• overuse of the wrist extensors
• tight forearm muscles

This can then lead to pain associated with activities in which this muscle is active, such as lifting, gripping, and/or grasping. Sports such as tennis are commonly associated with this, but the problem can occur with many different types of activities, athletic and otherwise.

What are the symptoms?  Symptoms may include:

• difficulty holding onto, pinching, or gripping objects
• pain, stiffness, or insufficient elbow and hand movement
• forearm muscle tightness
• insufficient forearm functional strength
• point tenderness at or near the insertion sites of the muscles of the lateral or medial elbow
• Pain is worse when shaking hands or squeezing objects.
• Pain is made worse by stabilizing or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife and fork.

How is it diagnosed?

Your health care provider will examine your arm and elbow, looking for tenderness and swelling.  You will also be checked for misalignments in your elbows, and wrists.

How is it treated?  Treatment includes the following:

• ·         Rest - this means avoiding further overuse not absence of activity. You should maintain as high an activity level as possible while avoiding activities that aggravate the injury. Absolute rest should be avoided as it encourages muscle atrophy, deconditions tissue, and decreases blood supply to the area, all of which is detrimental to the healing process. Pain is the best guide to determine the appropriate type and level of activity.
• ·         Place an ice pack over your lateral epicondyle for 15 to 20 minutes every 3 or 4 hours for 2 to 3 days or until the pain goes away.
• ·         You can also do ice massage. Massage your lateral epicondyle with ice by freezing water in a Styrofoam cup. Peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub ice over your knee for 5 to 10 minutes.
• ·         Adjustments of the elbow, and wrist.
• ·         Do the stretching exercises recommended by your health care provider or physical therapist.
• ·         Bracing to reduce the degree of muscle tension in the region of muscular attachment.

How long will the effects last?

The length of recovery depends on many factors such as your age, health, and if you have had a previous injury. Recovery time also depends on the severity of the injury. A tendon that is only mildly inflamed and has just started to hurt may improve within a few weeks. A tendon that is significantly inflamed and has been painful for a long time may take up to a few months to improve. You need to stop doing the activities that cause pain until the tendon has healed. If you continue doing activities that cause the tendon pain, your symptoms will return and it will take longer to recover.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activity will be determined by how soon your tendon recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your normal activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured arm compared to the uninjured arm.
• You have full strength of the injured arm compared to the uninjured arm.

How can I prevent Lateral epicondylitis?

The best way to prevent a lateral epicondylitis is to correctly warm up and stretch your forearm muscles before exercise. If you have tight forearm muscles, stretch them twice a day whether or not you are doing any sports activities that day. If you have a tendency to get lateral epicondylitis, strengthening and conditioning the muscles of the forearm and wrist will also help to prevent tennis elbow.  Keeping your body in alignment is key for all optimal performance in all activities.