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Lateral Epicondylitis (Tennis Elbow)
Lateral epicondylitis is inflammation of the tendon that attaches to the muscles of the forearm that bend the wrist back (extension). This inflammation is common on racquet sports such as tennis and also any job that requires repetitive bending of the wrist in a backward direction such as typing. Symptoms include pain and swelling on the outer side of the elbow, and pain may extend, on the outer side, up above or down below the elbow.
There will be a distinct point of pain when touching around the outer elbow (over the lateral epicondyle). Other symptoms include wrist weakness and pain when the wrist or fingers are pushed backwards against resistance.
Formation of loose bodies (Ostochondritis Dissecans)
The elbow joint is subjected to forces that cause quick contraction of the muscles to initiate and slow movement of the forearm. These forces cause the surfaces of the elbow joint such as bone and cartilage to hit each other. Cartilage and underlying bone from the joint become detached.
This detached cartilage and bone forms loose bodies in the joint causing further joint irritation and sometimes muscle spasm. This problem is seen mainly in throwing sports such as baseball and softball for example. Symptoms include swelling around the elbow and tenderness around the upper outer aspect of the elbow. Movement is usually restricted and uncomfortable and the elbow may lock intermittently.
Pronator Teres Syndrome ( Median Nerve Compression)
Entrapment of the median nerve in a muscle called the ‘pronator teres’ just below the elbow is a rare sporting injury incurred in sports such as squash. Symptoms include pain and tenderness in the middle of the front aspect of the elbow with pain and numbness being referred to the middle three fingers. A decrease in strength may be experienced with rotating the forearm outwards or bending the wrist forwards.
Referral Of Pain From Cervical and Thoracic Spine
The outside of the elbow is a common place for pain to be referred to from the neck and upper back. Many chronic elbow problems will have a component that has been caused by referral from the neck or upper back. Symptoms such as pain and stiffness in the neck or upper back may or may not accompany the referred elbow symptoms.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
‘Rolling Stick Exercise’
Attach a string with a weight at the end to the middle of a thin rounded stick, such as a cricket stump, and roll the stick so the weight moves up and down.
Wrist Extensor Stretch
Graduated Tennis Elbow Strengthening Program
This program is commonly used to manage tennis elbow problems. The aim of the program is to gradually strengthen and stretch the muscles of the forearm so they no longer become inflames during exercise or everyday use. This program should start off relatively easy and slowly progress to a solid strengthening program.
1. Slow Warm-up
A slow warm-up should be completed prior to this program. This should take approximately 5 minutes and could included some general ramge of movement exercises of the wrists and elbow.
2. Wrist extensor stretch
Stretches to be held for three sets of 20 to 30 seconds.
3. Wrist extension, progression of weights
Weight should be set and progressed each time the right weight so that 3 times 12 repetitions can be performed. This program should be performed on a daily basis. Minimal discomfort should be felt with this exercise.
4. Wrist Extensor Stretch
Ice, under a compression bandage, should be applied for approximately 5 to 10 minutes following this program. This will manage any unwanted inflammation resulting from th program.