tennis elbow

Quick Overview

• What is a tennis elbow (tennis elbow)? Painful overload of certain tendons in the area of ​​the elbow.
• symptoms: Pressure pain on the outside of the elbow, joint can no longer be fully stretched, weakness in the wrist
• Causes: Recurring movements in the elbow joint such as frequent computer work (especially work with the mouse), musicians (such as violinists) or athletes (such as rowers or tennis players)
• Diagnosis: Doctor-patient interview, various tests (movement and grasping tests), X-ray, if necessary magnetic resonance imaging (magnetic resonance imaging, MRI) or ultrasound
• Treatment: Rest, relieve, cool and later possibly warm, possibly special bandage and medication, stretching and strengthening exercises, etc. In some cases surgery.
• Doctor treating: orthopedist
• Forecast: Lengthy healing process, but good chances for complete recovery.

Tennis elbow: treatment

There is no universally accepted unified approach to tennis elbow treatment that has been scientifically proven to provide the best therapeutic results. In any case, however, the cause of the overload should be eliminated first: The elbow is sedated and spared, Conservative measures such as Cool and maybe Painkiller relieve the discomfort. Maybe wearing a special bandage or one Epicondylitis clasp, a kind of pressure bandage, make sense. Further possible therapeutic measures are, for example, ultrasound treatment as well as stretching and strengthening exercises. In severe cases, if the conservative tennis elbow treatment does not adequately help one can surgery to be necessary.

More about the different ways to treat a tennis elbow, read below:

Tennis elbow treat with conservative measures

Discharge: The goal of tennis elbow therapy is to restore the function of the muscular tendon unit in the elbow area. At first it is important to eliminate the corresponding cause (overload). In the case of an acute tennis elbow, the arm is initially spared, relieved, stored upright and, for example, supported with a tennis elbow. At the same time, you should avoid overexertion and stress in everyday life, work and sports.

For the time after recovery, it is important to correct the movement patterns that have allegedly triggered the tennis elbow: for example, by adapting the workplace (ergonomic computer mouse) or a technique training (for example, stroke technique in tennis). In addition, regular breaks can prevent re-overloading.

Stretching and strengthening: As part of the tennis elbow treatment at home, you can and should stretch and strengthen the arm muscles – but only if you no longer have severe pain in the execution of the exercises. Specific targeted strength training can be helpful in the early stages of the disease: According to experts, this reduces the blood flow at the appropriate place, which reduces the pain.

In addition, there are also special tennis elbow stretching exercises: For example, extend the elbow completely, turning the forearm inwards. Then carefully extend your sore hand so that your fingers are pointing outward. You should hold the tension for 15 seconds, then take a short break to finally start again. This workout can be repeated up to three times a day.

First, discuss such exercises with your physiotherapist or doctor and let them show you how to do it properly.

Physical therapy: Even with physical therapy measures can treat a tennis elbow. For example, massages of the wrist muscles as well as heat or cold treatments are suitable. Incidentally, whether to better cool or warm the tennis elbow depends on the stage of the injury: In the acute stage and after intensive exercise, soothing the cold (place towel wrapped in ice for 20 to 30 minutes, pause for 1 hour, repeat). In contrast, in a tennis elbow in a chronic stage heat is much more beneficial.

bandages: For severe discomfort, sufferers may wear a tennis elbow bandage (epicondylitis brace) over elbow and wrist for several weeks. It is available in some sports shops or at the medical supply store. The epicondylitis brace applies pressure to the corresponding muscles and tendons of the forearm with a small pad (pad) to better stabilize and relieve the extensor tendon approach. The pad is activated when you close the fist. The epicondylitis brace limits the mobility of the arm, which makes sense in this case: The “forced rest” can accelerate the healing process.

The pad should sit about five inches below the elbow joint. A finger should fit between the arm and the pillow.

taping: Even tape bandages and so-called Kinesiotapes can alleviate the discomfort of a tennis elbow under certain circumstances. To tap the tennis elbow properly, you can look at appropriate instructions on the Internet. But taping is easier and more professional for your physiotherapist.

medications: Often doctors put on tennis elear treatment anti-inflammatory drugs (either locally applied, for example in the form of gel or oral). Except the classical rheumatism drugs (anti-inflammatory drugs) there are also various painkillers, muscle relaxants, herbal supplements, enzymes and nucleotides. Which preparations are useful in individual cases, you should discuss with your doctor.

Ultrasound & Co .: Ultrasonic treatment can also be an effective means in a tennis elbow. It is used either to convey analgesic substances under the skin (Sonophorese) or to generate local heat. This improves the local blood circulation, relaxes the muscles and can thus promote the healing process.

Transcutaneous electrical nerve stimulation (TENS): The TENS is a gentle form of electrotherapy and is also called stimulation current therapy. It will deliver light electrical impulses to painful nerve fibers. This can inhibit the transmission of pain stimuli and so relieve the symptoms.

Infiltration Therapy: Some doctors inject patients with tennis elbow a local anesthetic to break the nerve line in the affected area and so to relieve the pain. Also, anti-inflammatory cortisone can be injected. It is also possible to inject the neurotoxin botulinum toxin (“Botox”) at the main pain point and in the affected muscles. This is for a few months “paralyzed” and can recover so.

Other treatment options include the Extracorporeal shockwave therapy (Pain relief by externally generated pressure waves), the X-ray irradiation stimulus (for anti-inflammatory and pain relief) and one laser treatment, Their effectiveness in a tennis elbow is only proven by a few studies.

Tennis arm operate

In principle, a tennis elbow treatment can also be carried out surgically. The surgeon cuts the tendon origin of the extensor muscles to relieve the tissue. In addition, sometimes two millimeters of the bone crest of the bony prominence of the humerus are knocked off.

Such an intervention achieves good results in most cases. However, it is advisable only in severe cases of tennis elbow, if a conservative treatment over several months was not successful. For example, surgery may be indicated in the case of long-lasting and very severe pain that limits everyday life. Even with patients who have accompanying injuries in addition to the tennis elbow, surgery may be necessary.

Tennisarm & Homeopathy

Some patients with tennis elbow treat their complaints with homeopathic remedies, in addition to conventional medical measures. For example, for acute inflammation and pain Arnica help. If the pain subsides with a slight movement, it often becomes Rhus toxicodendron recommended. If, on the other hand, every movement is painful Bryonia be more suitable. In addition, applies Ruta as a proven remedy for tendon and periosteal injuries.

Tennis elbow: symptoms

Typical symptoms of tennis elbow are pressure pain on the outside of the elbow. They are noticeable in the tendon insertion of the hand and finger extensor muscles.

In addition, sufferers usually can not stretch the elbow joint completely.

Another tennis elbow symptom can be a weakness in the wrist. Strong access, a strong grip, a strong grip when shaking hands or just holding a cup is then often no longer possible.

Here is a summary of typical tennis elbow symptoms:

• Gentle posture – the elbow can no longer be stretched
• Pressure pain on the outside of the elbow
• motion pain
• Weakness in the wrist
• no power to close a fist
• Tingling in the hand

Tennis elbow: causes and risk factors

A tennis elbow is caused by an overload on the outside of the elbow. Stressful, recurrent movements or a sudden increase in load without adequately prepared muscles result in microscopically small cracks in the tissue. Tendons and fibrocartilages are most susceptible to such minor injuries (microtrauma). The resulting pain may radiate to the upper or lower arm.

Basically, a tennis elbow can be favored by the following risk factors:

Unilateral load: Both an overload in sports as well as monotonous movements with low stress in everyday life and work can be the cause of a tennis elbow. For example, people who work a lot on the computer (especially work with the mouse), certain craftsmen (frequent hammering!), Musicians (like violinists), domestic workers (many ironing!) And athletes (such as rowers or tennis players) easily develop a tennis elbow ,

A weak forearm muscles as well as one higher age (Declining tendon elasticity!) additionally favor micro injuries in the area of ​​the elbow and thus a tennis elbow.

(Earlier) diseases and treatments: Sometimes, previous illnesses can be the cause of a tennis elbow. This may be a past accident or joint disease. Prior conservative or operative treatment in the elbow area may also increase the risk of a tennis elbow.

Most commonly, the tennis elbow occurs in people in the fourth decade of life.

golfer

As with the tennis elbow, the golfer’s arm is overloaded by recurring movement patterns that trigger pain in the arm area. While in the tennis elbow, however, the outside of the elbow is affected, arise in the much rarer golfer (Epicondylitis humeri ulnaris), the discomfort of the Inside of the elbow.

Like the tennis elbow, the golfer’s arm not only meets a certain group of athletes (golfers), but also gymnasts, weightlifters and strength athletes in free-weight training, for example, if they want to compensate for this lack of technique.

The treatment of the golfer’s arm is similar to that of the tennis elbow. The prognosis is comparable: Often, the symptoms disappear automatically. If not, the chances of a complete cure are as good as possible if treated as early as possible. However, the healing process can take a while.

Find out more about how to identify a golfer’s arm and what you and your doctor can do to help relieve the pain in the Golferarm article.

Tennis elbow: examinations and diagnosis

If you suspect a tennis elbow, you should go to the family doctor. Some patients also go directly to a specialist in orthopedics. The doctor will first talk to you in detail to record your medical history. This is followed by a physical examination with various tests. To exclude other causes of the pain, he can perform additional imaging tests (such as X-rays).

anamnese

In an anamnesis interview, the doctor inquires about the exact symptoms, possible injuries or previous illnesses as well as possible triggers of the symptoms. These infomrations help the doctor to limit the cause of the discomfort. Possible questions from the doctor include:

• Did you injure your arm, perhaps by falling?
• Have you ever had discomfort on your arm for no apparent reason?
• Where exactly do you feel pain?
• Is it a movement or a resting pain?
• Are activities by hand, for example, vigorous gripping painful?
• Does the arm or hand feel powerless due to the pain?
• What are you working on? Which sport do you do?

Physical examination and tests

After the patient talk, the doctor examines your arm. Even at first glance, one can posture of the arm: Many patients with tennis elbow instinctively keep the elbow calm and avoid fully stretching the forearm. For a more detailed clarification, the doctor scans the elbow and checks whether certain areas painful to pressure react.

Also important for the diagnosis are so-called provocation tests: The doctor asks you, for example, the hand in the Wrist against resistance to stretch (moving the back of the hand towards the forearm). This causes pain in a tennis elbow, because it usually affects the spokes-side hand extensor (extensor carpi radialis brevis muscle). The superficial extensor of the forearm (M. extensor digitorum communis) often murmurs on the tennis elbow: in this case, it hurts when the Middle finger stretched against a resistance shall be.

Characteristic of a tennis elbow is also the so-called “coffee-cup test“. And this is to be taken literally: The doctor lets you lift a full cup with the hand of the affected arm. If you are in pain, this indicates a tennis elbow. Also revealing is the Chair test: With your arm outstretched and with your forearm turned inwards, you must lift a chair by its back with one hand. This is very painful with a tennis elbow.

To rule out other possible causes of the condition, the doctor will also examine your cervical spine, shoulder, and hand, and assess blood flow, motor function, and sensitivity (including nerve constriction) in the affected arm.

Imaging studies

Using an X-ray, the doctor can rule out some other potential causes of elbow pain, such as osteoarthritis. With a tennis elbow, the radiograph is usually inconspicuous. In some patients, although calcification of the tendon insertion is recognizable – this does not affect the course of the disease.

In addition, a magnetic resonance tomography (MRI) or an ultrasound examination can be made. This is especially done for unclear elbow injuries. The doctor can exclude a tumor using these examination methods, for example. In case of chronic ailments, MRI shows the degree of wear of the tendon. This in turn gives indications of the expected course of the disease.

Tennis elbow: course and forecast

The forecast for the tennis elbow is good. However, the treatment can be lengthy. Patients have to adjust to several months of painful movement and stress impairments.

In around 80 out of 100 people affected the symptoms disappear completely within one year. In many cases, conservative treatment such as medication, physiotherapy and infiltration therapy is sufficient. Surgery is only necessary if other therapies have no effect and / or the patient has severe symptoms for a long time.

The general rule for the tennis elbow is that the earlier the therapy is started, the greater the chances of success. Also, the therapy should be carried out consistently, otherwise the pain can become stronger and even chronic.

Prevent tennis elbow

For example, if you are prone to a tennis elbow due to your job or a (sporting or musical) hobby, you can do some things to prevent (re) overloading. For example, strengthen the muscles of the arms through regular exercise, take a break from the monotonous movement and go at first signs of one tennis elbow to the doctor.