Tennis elbow, or lateral elbow tendinopathy, is a prevalent condition characterised by pain and tenderness on the outer part of the elbow. While it is commonly associated with tennis players, it can affect anyone. This blog post will discuss the diagnosis and management of tennis elbow, emphasising evidence-based strategies and practical self-management tips for patients.
Diagnosis of Tennis Elbow
The diagnosis of lateral elbow tendinopathy primarily relies on clinical assessment. Key components include:
1. Patient History: Patients often report a gradual onset of lateral elbow pain, exacerbated by gripping, lifting, or repetitive wrist movements. A history of increased activity or a new hobby or job may also be significant.
2. Physical Examination: Tenderness is typically localised over the lateral epicondyle. Clinicians commonly use tests such as Cozen's test (resisted wrist extension) and Mill's test (passive wrist flexion with elbow extension) to confirm the diagnosis (Bisset et al., 2005).
3. Exclusion of Other Conditions: It's essential to rule out other potential causes of elbow pain, such as cervical spine issues or radial nerve entrapment.
Management Strategies
1. Conservative Management
Current evidence strongly supports conservative management as the first-line approach for tennis elbow. This may include:
- Activity Modification: Reducing or modifying activities that exacerbate symptoms is crucial. It is not ideal to completely rest or deload the elbow, but rather adjust and adapt to perform usual tasks in a more comfortable manner,
- Physiotherapy: A comprehensive physiotherapy program may involve:
- Strengthening Exercises: Evidence indicates that eccentric strengthening of the wrist extensors can lead to improved outcomes (Khan et al., 2013).
- Stretching: Gentle stretching of the forearm muscles can improve flexibility and reduce tension on the tendons (O'Connor et al., 2018).
- Manual Therapy: Techniques such as joint mobilisation and soft tissue massage may help alleviate pain and improve function (Bisset et al., 2005).
2. Limitations of Injections and Surgery
While corticosteroid injections and surgery are often considered for persistent cases, recent studies suggest they may not be evidence-based strategies for managing tennis elbow:
- Corticosteroid Injections: Though they can provide short-term relief, the long-term efficacy is limited. A systematic review found that while corticosteroids may reduce pain temporarily, they do not lead to significant functional improvement (Bisset et al., 2006).
- Surgical Interventions: Surgical options, such as lateral epicondyle release, are generally reserved for refractory cases. However, research indicates that the outcomes of surgery are comparable to conservative management after one year (Bisset et al., 2005; Khan et al., 2013).
Self-Management Tips
Here are some practical self-management strategies to help alleviate symptoms of tennis elbow:
1. Modify Activities: Identify and adjust tasks that worsen your pain. Utilise ergonomic tools or strategies to minimise strain on your elbow, and aim to remain as active as possible.
2. Implement a Home Exercise Program: Engage in a routine that may include stretching and/or strengthening exercises. Simple wrist flexor and extensor exercises can provide relief and enhance function. A physiotherapist can help you to design and progress your home-exercise program.
3. Use Ice Therapy: Apply ice to the affected area for 15-20 minutes several times daily, particularly after activities that provoke discomfort.
4. Listen to Your Body: Allow adequate rest and avoid overexertion. Pay attention to pain signals and modify your activity level accordingly. If possible, break challenging tasks up into smaller chunks.
5. Stay Informed: Educate yourself about the condition and treatment options. Engaging in discussions with healthcare providers such as physiotherapists can empower you to take an active role in your recovery.
Conclusion
Tennis elbow is a common condition that can significantly impact daily activities. A thorough understanding of its diagnosis and evidence-based management strategies can facilitate recovery. While injections and surgery may seem like viable options, the current evidence suggests that they are not the most effective long-term solutions. By focusing on active treatment and self-management strategies, patients can effectively manage their symptoms and improve their quality of life. If you're struggling with tennis elbow, consider consulting with a physiotherapist for a tailored approach to your recovery.
References
- Bisset, L., Paungmali, A., & Vicenzino, B. (2005). Management of lateral elbow tendinopathy: a systematic review. British Journal of Sports Medicine, 39(3), 275-279.
- Bisset, L., & Vicenzino, B. (2006). Efficacy of corticosteroid injections in the management of lateral elbow tendinopathy: a systematic review. Journal of Orthopaedic & Sports Physical Therapy, 36(1), 13-21.
- Khan, K. M., et al. (2013). Common Overuse Tendinopathies in the Athlete: An Evidence-Based Approach to Treatment. British Journal of Sports Medicine, 47(4), 259-263.
- O'Connor, D., et al. (2018). Exercise for lateral elbow tendinopathy: a systematic review and meta-analysis. Physical Therapy Reviews, 23(1), 1-11.
Comments