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What is a tennis elbow?
Tennis elbow, medically known as lateral epicondylitis, is a condition characterised by pain and tenderness on the outside (lateral part) of the elbow. It is caused by overuse or strain of the forearm muscles and tendons, especially through repetitive wrist and arm motions.
Despite its name, tennis elbow does not just affect tennis players; it can occur in anyone who repeatedly uses their wrist or clenches their fingers, such as painters, plumbers, gardeners, and people who perform manual work or play racquet sports. The pain of tennis elbow varies from mild discomfort while performing certain activities to severe pain that can be present even at rest.
What causes tennis elbow?
Tennis elbow is primarily caused by overuse and repetitive strain on the muscles and tendons of the forearm near the elbow joint. Specifically, it occurs when the tendons that attach the forearm muscles to the outside of the elbow become inflamed or develop small tears from excessive strain. Here are the main causes of tennis elbow:
- Repetitive motions: activities that involve repeated use of the forearm muscles, such as swinging a tennis racket, painting, using tools like screwdrivers or hammers, or performing manual labour, can lead to tennis elbow.
- Excessive force: using too much force or performing activities that require forceful and repetitive gripping or twisting of the arm can strain the elbow’s muscles and tendons, resulting in tennis elbow.
- Improper technique: performing activities with poor form or technique can put unnecessary stress on the elbow joint and its surrounding muscles and tendons, causing tennis elbow.
- Sudden increase in activity: individuals who suddenly increase the intensity, duration, or frequency of activities that involve using the forearm muscles may be at higher risk.
- Occupational risk factors: jobs that involve repetitive and forceful movements of the arm and wrist, like construction work, plumbing, or butchery, can increase the risk of developing tennis elbow.
While it is called “tennis elbow,” less than 5% of cases are related to tennis. It is more commonly seen in people between the ages of 30 and 50, and it can affect anyone who engages in activities that put a repetitive strain on the elbow joint.
What are the symptoms of tennis elbow?
The symptoms of tennis elbow primarily revolve around pain and tenderness in the elbow and forearm. Here are the common symptoms of tennis elbow:
- Pain and tenderness: the most common symptom of tennis elbow is pain and tenderness on the outside of the elbow, which extends down the forearm. The pain might increase when performing activities that involve gripping or lifting.
- Stiffness: the elbow may feel stiff, and making a fist might be painful.
- Weakness: there might be a noticeable weakness in the wrist and forearm, making it difficult to perform simple tasks such as opening a jar or holding a cup.
- Grip problems: experiencing difficulty or pain while gripping objects, especially when performing twisting motions like turning a doorknob or using a screwdriver.
- Elbow pain: the pain might increase when you extend, lift, or bend your arm. Activities that put stress on the forearm muscles, like lifting, using tools, or even shaking hands, can exacerbate the pain.
- Radiating pain: in some cases, the pain can radiate from the outside of the elbow into the forearm and wrist.
These symptoms can develop gradually over time, especially if the condition is due to repetitive overuse. In some cases, they might appear suddenly, especially if triggered by a specific injury or strain.
Who is at risk of tennis elbow in Singapore?
In Singapore, certain groups of people are at higher risk of developing tennis elbow; these include:
- Middle-aged individuals: people between the ages of 30 and 50 are more commonly affected by tennis elbow, as it is often the result of wear and tear and repetitive use over time.
- Athletes: while it is called tennis elbow, the condition is not limited to tennis players. Athletes who engage in sports that require repetitive arm, elbow, and wrist movements, such as badminton, squash, and golf, are at higher risk.
- Manual labourers: individuals whose jobs involve repetitive motions or heavy lifting, such as construction workers, painters, carpenters, and plumbers, are more likely to develop tennis elbow. The frequent and repetitive nature of their work strains the muscles and tendons of the forearm.
- Office workers: individuals who work in an office environment, especially those who use a computer mouse or keyboard extensively without proper ergonomic support, can also be at risk. Repetitive strain injuries, including tennis elbow, can occur from prolonged computer use.
- Musicians: musicians, particularly those who play string instruments or percussion, may be at risk due to the repetitive movements and postures required to play their instruments.
To reduce the risk of developing tennis elbow, individuals in these groups should focus on using proper techniques in their activities, ensuring ergonomic setups at work, taking regular breaks to rest the muscles, and doing exercises to strengthen the forearm muscles.
How is tennis elbow diagnosed?
Tennis elbow is diagnosed through a combination of medical history review, physical examination, and sometimes imaging tests. Here’s how the process generally unfolds:
- Medical history: your pain specialist will ask about your symptoms, activities that may be contributing to the pain, and any previous elbow injuries. Understanding the nature of your work and recreational activities can provide clues to the diagnosis.
- Physical examination: your elbow will be examined for tenderness, swelling, and pain.
- Imaging tests: while not always necessary, imaging tests like X-rays can rule out other conditions that could be causing elbow pain, such as fractures or arthritis. In some cases, more detailed imaging, such as magnetic resonance imaging (MRI), might be used to assess the severity of the tendon injury.
- Palpation: the area may be palpated to pinpoint the source of pain. The most tender area is usually found over the lateral epicondyle, which is a bony bump on the outside of the elbow.
- Functional tests: these tests assess the strength of the forearm muscles and the pain elicited during specific movements. One common test is Mill’s test, which involves extending the fingers and wrist against resistance while keeping the elbow straight; if this motion causes pain on the outside of the elbow, it suggests tennis elbow.
Through these methods, doctors can diagnose tennis elbow and rule out other potential causes of elbow pain, which can help devise an appropriate treatment plan.
What are the treatment options for a tennis elbow in Singapore?
Treatment for tennis elbow aims to relieve pain, reduce inflammation, and promote healing of the affected tendons. Here are the common treatment options for tennis elbow:
- Rest and activity modification: it is crucial to avoid activities that exacerbate the pain. Resting the affected arm and modifying activities can reduce strain on the elbow and allow the tendons to heal.
- Ice therapy: applying ice to the affected area can help reduce inflammation and pain.
- Pain relief medications: over-the-counter pain relievers such as ibuprofen, naproxen, or acetaminophen can help alleviate pain and inflammation.
- Physical therapy: a physical therapist can teach exercises that stretch and strengthen the forearm muscles. Physical therapy may also include techniques like massage or muscle stimulation to improve healing.
- Braces or orthotic devices: wearing a brace or forearm strap can reduce stress on the injured tendons and redistribute forces away from the affected area, which can help alleviate pain.
- Steroid injections: corticosteroid injections around the painful area can reduce inflammation and pain. However, their effects are usually temporary, and there may be limits to how many injections can be given.
- Extracorporeal Shock Wave Therapy (ESWT): ESWT is a non-invasive treatment that uses shock waves to stimulate healing in the injured tendon.
- Platelet-Rich Plasma (PRP) Injections: PRP injections involve injecting a concentration of the patient’s own platelets into the tendon to promote healing. This method is gaining popularity for treating chronic tendon injuries.
The choice of treatment depends on the severity of the symptoms, the duration of the condition, and how much the pain interferes with daily activities. Most people recover with non-surgical treatments, but it is important to address the condition early to prevent chronic problems.
If you are suffering from a tennis elbow, schedule an appointment with us today for a thorough diagnosis and an appropriate treatment plan.
Frequently asked questions
Recovery from tennis elbow can vary, typically lasting from several weeks to a few months, depending on the severity of the condition and how well the treatment plan is followed. Consistent physical therapy and avoiding aggravating activities can speed up the healing process.
While playing sports regularly, you can minimise your chances of developing a tennis elbow by using proper technique, ensuring appropriate equipment fit (like the right grip size for racquets), and incorporating forearm strengthening and flexibility exercises into your routine. Regular breaks and avoiding overuse are also crucial.
Tennis elbow can affect anyone, not just athletes. It occurs in individuals who engage in activities that involve repetitive arm, wrist, and hand movements, including manual labourers, office workers, and hobbyists.
Tennis elbow affects the outer part of the elbow and is associated with pain in the lateral epicondyle, while golfer’s elbow affects the inner part of the elbow and involves pain in the medial epicondyle. Both are caused by overuse and repetitive motion but involve different tendons.
Total Pain Specialist