Epicondylitis

Lateral epicondylitis or tennis elbow causes injury to the tendons that connect the muscle to the bone on the outside of the elbow. Injuries are caused by overuse and / or repetitive movements, such as hitting a tennis ball with a racket or making  continual movements with  a screwdriver. Over  time,  tennis elbow can cause constant pain on the outside of the forearm. In some cases, the pain may spread to the forearm and wrist.

Usually rest and over the counter painkillers help relieve the pain, but if conservative treatments do not help or if the symptoms are disabling, you may need surgery.

Symptoms

The pain associated with tennis elbow may spread to the outer part of the elbow, forearm and wrist. The resulting pain and weakness may make it difficult to:
• use your hand for shaking hands or turning a handle
• hold certain items in your hand, such as a glass or a cup of coffee

Medical examination: When?

You should contact your doctor if self medication remedies such as rest, ice packs and the use of over the counter painkillers do not help reduce the pain.

Causes

Tennis elbow is caused by the repeated contraction of the forearm muscles, which are muscles that you use to straighten and raise your hand and wrist. The repetitive motions can cause inflammation –  a series of tiny tears in the tendons that attach the muscles of the forearm to the bony prominence on the outside of the elbow (lateral epicondyle).

As the name suggests, playing  tennis – especially with repeated use of a backhand with  poor technique – is one of the possible causes of this condition. In addition to tennis, many other common arm motions can cause tennis elbow, including:
• the use of hydraulic  tools
• painting
• tightening screws
• excessive use of the mouse

Risk Factors

Factors that may increase the risk of developing tennis elbow are:
• Age: Although tennis elbow affects people of all ages, it is most common in adults between the ages of 30 and 50 years.
• Occupation: people doing work involving repetitive movements of the wrist and arm are more likely to develop tennis elbow. Certain groups at risk are plumbers, painters, carpenters, butchers and cooks.
• Some sports: sports that use a racquet increase  the risk of developing tennis elbow.

Complications

If left untreated, tennis elbow can cause chronic pain, especially when lifting or gripping objects. The condition may also worsen if the elbow is used extensively before it is completely healed.

Tests and diagnosis

In many cases, the clinical history and physical examination provide sufficient information for a proper diagnosis. However, if the doctor suspects some other pathology, it is possible to prescribe further examination such as:

• X-rays to rule out other possible causes of elbow pain such as fractures or arthritis.
• MRI, as some neck problems, such as herniated discs, the disc protrusion or cervical arthritis can cause symptoms similar to those of tennis elbow.
• Electromyography to see if the symptoms are due to a pinched nerve.

Treatment and drugs

Tennis elbow is a painful condition but one which often resolves itself on its own. However, if the over the counter pain relief medication and other measures of self-medication does not help, your doctor may suggest physical therapy. In severe cases surgery may be required.

Physical therapy

• Use of bandages and braces help decrease overload to the tendon and therefore lessen pain. You can also find wrist cuffs  on the market which are effective in reducing stress to the tendons.

• You can change the way in which you deal with certain activities, for example, changing the technique when playing tennis or using ergonomic measures to ensure that wrist and forearm movements  do not contribute to a worsening of the symptoms.
• Stretching and exercising  strengthen the muscles connected to the elbow and decrease pain. Usually these exercises can be done at home, but in more severe cases you may need the help of a physiotherapist.

Ozone Therapy

The mixture of Oxygen-Ozone has been used successfully in the early and middle phase of epicondylitis due to it’s anti-inflammatory action. Injections are made into the painful region by using extremely thin needles. Normally carrying out 8-10 injections at intervals of 3-4 days. Ozone Therapy singularly causes no harm to tendons and does not leave  microcrystalline formed pockets as is found in local administration of some slow-release forms of cortisone. After the Ozone Therapy cure it is essential to begin a rehabilitation programme.

Treatment with cortisone injections

Treatment with cortisone is indicated during the initial stages of epicondylitis. Normally  2-3 local injections are made with the aim of reducing  inflammation. After the use of cortisone injections it is essential to begin a rehabilitation programme. 

Surgery


If after one year of conservative therapy the symptoms have not improved, you may need to resort to surgery to remove damaged tissue. After surgery it  is essential to begin a rehabilitation programme. 

Lifestyle

The five steps to protect the elbow affected by epicondylitis are:
1. Protection. Protect the elbow from further injury by resting it.
2. Rest. The elbow should not be over worked but also not kept immobile. In many cases it is sufficient to decrease the symptoms at night by wearing an elastic bandage/brace on the forearm.
3. Ice. To reduce swelling you can use ice, massage with the ice pack, cold water immersions or wear the elastic bandage/brace soaked in cold water. At onset of pain you should apply ice as soon as possible.
4. Compression. To compress the injured area you can use a bandage or elastic brace.
5. Elevation. To prevent or reduce swelling try raising the arm.