Tennis Elbow

Mr. John, 44 years old come to clinic complains about the pain at the outer side of the elbow joint radiate down to the wrist, feels very tender when to touch. He is a tennis player and he plays 3 times in a week. The doctor told him that he has a tennis elbow and after having some medication and rest the pain resolves.
Tennis Elbow, in medical term called Lateral Epicondylitis, is a condition when the outer part of the elbow becomes painful and tender, usually as a result of a specific strain, overuse, or a direct bang. Sometimes no specific cause is found.
Although playing tennis is one cause of tennis elbow, many other common activities, which are over using their arm doing something else can cause the condition. These activities may include: Using a screwdriver, painting, carrying heavy weights, motions used in gardening, knitting, typing
The most common cause is over use of the extensor muscles of hand which are attached to the bone at the outer part of the elbow (lateral epicondyle). If they are strained or over used they become inflamed, which means they are swollen, painful and tender to touch in that area.
Sometimes the inflammation is caused by a direct injury or bang. Sometimes, especially when the cause is direct injury or strain, the muscles are actually partially torn.
Rarely the inflammation comes on without any definite cause, and this may be due to an arthritis, rheumatism or gout. Sometimes the problem is partly or completely due to a neck problem, which is causing pain in the elbow via the nerves from the neck.
Sign and symptoms
Signs and symptoms of tennis elbow may include:
• Pain that radiates from the outside of your elbow into your forearm and wrist
• Pain when you touch or bump the outside of your elbow
• A weak grip
• A painful grip, such as when you shake hands or grip a doorknob
• Pain when you straighten or extend your wrist or hand
• Pain in your elbow when lifting something heavy
• Pain during repetitive movements of your wrist
Sometimes, you may feel pain even when you aren't moving your arm.

Diagnosis
The doctor or physiotherapist will test for tenderness over or near to the bony bump on the outside of the elbow. Doctor will also test to see whether the pain gets worse when you bend the wrist back (extend it) against resistance. In the event of both these signs being present, it is likely that you have tennis elbow.
Your doctor may also examine your neck, as this may be the cause, or part of the problem. After all many of the things that might strain your elbow might also put a strain on your neck.



Treatment

Initial treatment of tennis elbow usually involves self-care steps including rest, icing the area and use of acetaminophen or over-the-counter (OTC) anti-inflammatory medications. If those steps don't help and you still have pain and limited motion after a week or so, your doctor may suggest other steps. These may include:
• Prescription medications. If your use of OTC medications hasn't reduced pain and inflammation, your doctor may prescribe stronger medications for a short period of time.
• Exercises. Your doctor or physical therapist may suggest exercises to gradually stretch and strengthen your muscles, especially the muscles of your forearm. Once you've learned these exercises, you can do them at home
or at work. Your doctor may also suggest you wear straps or braces to reduce stress on the injured tissue.
• Corticosteroids. If your pain is severe and persistent, your doctor may suggest an injection of a corticosteroid medication. Corticosteroids are drugs that help to reduce pain, swelling and inflammation. Injectable cortico-steroids rarely cause serious side effects, although they may temporarily raise blood sugar levels in people with diabetes. Application of topical corticosteroids for pain relief may also suggested.
• Surgery. If other approaches haven't relieved your pain after rehabilitation program and given it enough time, and if the activity of your arm is still restricted, your doctor may suggest surgery. The goal of surgery is pain relief, and there are several different operations currently performed for this problem.

While you are recovering from your injury you will need to avoid repetitive motion of the elbow and to change your sport or activity to one that does not make your condition worse. For example, you may need to run instead of play tennis. If you play tennis, your doctor may advise you to use a tennis racket with a larger grip and improve in the way you hold or swing your racket.
Return to sport or activity
The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your sport or activity will not be determined by how many days or weeks it has been since your injury occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better.
You may return to your sport or activity when your are able to forcefully grip your tennis racket, bat, or golf club, or do activities such as working
at a keyboard without pain in your elbow. In sports such as gymnastics, it is important that you are able to bear weight on your elbow painlessly. It is important that there is no swelling around your injured elbow and that it has regained its normal strength compared to your uninjured elbow. You must have full range of motion of your elbow.

How can I prevent tennis elbow?

• Use proper form during your activities, whether they are sports or job-related. For instance, be sure your tennis stroke is correct and that your tennis racket has the proper grip size.
• Warm up before playing tennis or doing other activities that involve your elbow or arm muscles. Gently stretch your elbow and arm muscles before and after exercise.
• Ice your elbow after exercise or work.
• In job-related activities, be sure your posture is correct and that the position of your arms during your work doesn't cause overuse of your elbow or arm muscles.