Sunday, October 21, 2007

Tennis elbow

From time to time I am asked to provide some assistance in dealing with the problem
commonly referred to as tennis elbow. Usually, the inquiries are from my baseball playing son after an intense game where he has taken on more of pitching job than his arm anticipated.

What is tennis elbow?

The official diagnosis is: lateral epicondylitis. These terms serve to identify the outside of the elbow as the region involved and inflammation of the common wrist extensors as the primary source of the problem. The condition is almost entirely an overuse syndrome. The onset with tennis players can usually be traced to a technique change or alteration in their backhand stroke, where intermediate players for one reason or the other "break the wrist" and repeatedly extend the wrist rather than keep the wrist straight and part of and extension of the arm and racquet.

For the rest of us - any repeated extension of the wrist may be enough to set off this condition. For example, hammering, computer work and with the recent election excessive hand shaking. The borrowed picture below, shows where the wrist extensors take their origin. When excessive tension is applied there can be quite a reaction at the bony attachment.

Some controversy exists regarding the pathology of tennis elbow. While largely thought as a musculotendionous disorder, the lateral elbow pain can arise from intra-articular, tenoperiosteal causes as well as from radio-humeral bursitis, radial nerve entrapment or in some cases be referred from the cervical spine.

Common treatments:
1. as shown in photo below, some find using an epicondylitis clasp provides relief - much like grasping or holding the muscle to reduce it's pull on the bony attachment.
2. cryotherapy - ice to the region (with caution), usually an ice pack over a moist cloth for 8 minutes can be very effective.
3. stretch the wrist extensors gently(by bending the wrist) - hold for 20-30 seconds, repeat 4-5 times
4. strengthen the muscles - use a small weight(4-5 lbs). place wrist over knee and lower the weight slowly, use the other hand to bring the weight back to the start position. repeat 6-8 times 3 sets
5. ice again
6. modify what you do and how you do it.

For some, the use of acupuncture has been a great addition to the overall treatment -exercise and technique correction. Acupuncture as it relates to relevant anatomy of the region appears to have a sound rationale. The radial nerve is a continuation of the posterior cord of the brachial plexus and receives contributions from C5, C6, C7 and C8 nerve roots. On entering the forearm the radial nerve and it's divisions are in close contact with the radio-humeral joint.

The anatomy slide shows a point in the forearm, between the radius and ulna that stimulates the extensor muscles and the radial nerve. There are three points in the forearm that can be used for tennis elbow and three near the muscle attachment at the elbow.

If you are a tennis player the force to serve or return a serve as a ground stroke, either forehand or backhand can be substantial - consider the following:
1. grip size - is it accurate for you? too little and too big can both promote excessive wrist extension.
2. head size - while oversized raquets are popular and can be very effective they may not be for everyone, especially since the added torque is significant if your shots are off centre.
3. tension on the strings - high tension can increase vibration and torque and these forces can be transmitted through the racquet to your arm.

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