What is Tennis Elbow?

What is Tennis Elbow?
What is Tennis Elbow?
Tennis elbow, or lateral epicondylitis is a condition in which there is pain in the outer aspect of the elbow. 
Tennis elbow can be categorised into two types:
 -TRUE tennis elbow
- FALSE tennis elbow

TRUE tennis elbow occurs when there is injury or inflammation of the extensor muscles in the forearm. In most cases, the Extensor Carpi Radialis Brevis is involved. It is due to overuse of the forearm extensor muscle (such as in racquet sports) or due to eccentric overload of the tendon secondary to forearm muscles tightness.

  • Stiffness in morning
  • Pain in the outer aspect of the elbow
  • Pain with resisted wrist extension
  • Pain with gripping activities
  • Decreased grip strength
How BENPHYSIO explains the problem: 
Despite the name of this condition, tennis players are not the only ones who can suffer from this condition. If your daily activity involves a lot of house chores, repetitive wrist movements (eg: gripping and twisting), sudden heavy lifting, and forceful pronation and supination of the forearm, you may also develop tennis elbow. This is because overuse of flexor muscles of the forearm (gripping & bending wrist) can cause an eccentric stress to the forearm extensor muscles, leading to injury/overloading of the tendons.

What are the common tests used to identify true tennis elbow?
Resisted wrist extension test
​In this test, patient is asked to extend his/her wrist while the examiner provides a resistance force to the movement. The test is positive for TRUE tennis elbow if pain at the elbow is reproduced.
Physiotherapy treatment:
  • cepack & compression to reduce inflammation
  • Myofascial release of the both forearm muscles
  • Stretching exercises to reduce forearm muscle tightness
  • Stretching exercises to prevent scar formation of extensor muscles
  • Strengthening exercises for the forearm muscles to allow the tendons to withstand load during functional activities better (30% loading phase)

FALSE tennis elbow

There are many untreated Tennis Elbow. Why?
FALSE tennis elbow mimics the symptoms of true tennis elbow (pain in the outer aspect of elbow) but it is NOT caused by a dysfunction/inflammation of the Extensor Carpi Radialis Brevis tendon.
One of the most common causes of FALSE tennis elbow is a neck dysfunction/C5-C6 syndrome.
How does neck dysfunction cause false tennis elbow?
Dermatomes & myotomes:
Dermatome is an area of skin supplied by a single nerve that comes out of the spinal cord.
Imagine the human body as a map, each dermatome represents the area which a spinal nerve provides sensory information to.
Myotomes is defined as a group of muscles innervated by a single nerve that comes out of the spinal cord.
C5 & C6 radiculopathy
Cervical radiculopathy is a clinical condition that is caused by cervical nerve root compression usually from degenerative changes or poor posture or soft tissues changes.
The symptoms usually depend on the level of the nerve root compression. In C5-C6 cervical radiculopathy, the symptoms may include:
  • Referral pain down the arm near the lateral epicondyle of humerus, which can easily be mistaken as tennis elbow.
  • Numbness and tingling sensation in the arm, forearm, and hand.
  • Weakness of the arm, forearm muscles, thumb, index finger, and middle finger.
How to test for false tennis elbow caused by C5-C6 syndrome?
  • Negative resisted wrist extension test
  • Cervical joint assessment (check for stiffness/pain/improper movement pattern)
  • Tightness in the neck and shoulder muscles
Physiotherapy treatment for FALSE tennis elbow caused by C5-C6 syndrome:
  • Stretching exercises for neck such as cervical flexion, cervical rotation, cervical side bend, upper trap and levator stretch
  • Stretching exercises for shoulder such as chest stretching
  • ​Chin tuck strengthening exercise

Other possible causes of outer elbow pain:
  • Ligamentous instability
  • Intra-articular pathology (Elbow joint movement dysfunction)
  • Posterior interosseous nerve entrapment
  • Posterior interosserous nerve entrapement
  • Radial nerve injury
  • Shoulder injuries

07 May 2021