What is Tennis Elbow?
Tennis elbow (also known as “Shooter’s elbow” and “archer’s elbow”) is a condition where the outer part of the elbow becomes sore and tender. It is commonly associated with playing tennis and other racquet sports, though the injury can happen to almost anybody.
The condition is also known as lateral epicondylitis “inflammation of the outside elbow bone”, a misnomer as histologic studies have shown no inflammatory process. Other descriptions for lateral epicondylitis are lateral epicondylosis, lateral epicondylalgia, or simply lateral elbow pain.
Runge is usually credited for the first description in 1873 of the condition. The term tennis elbow was first used in 1883 by Major in his paper “Lawn-tennis elbow”.
The strongest risk factor for lateral epicondylitis is age. The peak incidence is between 30 to 60 years of age. No difference in incidence between men and women or association between tennis elbow and the dominant hand has been demonstrated.
The pathophysiology of lateral epicondylitis is degenerative. Non-inflammatory, chronic degenerative changes of the origin of the extensor carpi radialis brevis (ECRB) muscle are identified in surgical pathology specimens. It is unclear if the pathology is affected by prior injection of corticosteroids.
Among tennis players, it is believed to be caused by the “repetitive nature of hitting thousands and thousands of tennis balls” which leads to tiny tears in the forearm tendon attachment to the elbow.
The extensor digiti minimi also has a small origin site medial to the elbow which can be affected by this condition. The muscle involves the extension of the fifth digit and some extension of the wrist allowing for adaptation to “snap” or flick the wrist – usually associated with a racquet swing. Most often, the extensor muscles become painful due to tendon breakdown from over-extension. Improper form or movement allows for power in a swing to rotate through and around the wrist – creating a moment on that joint instead of the elbow joint or rotator cuff. This moment causes pressure to build impact forces to act on the tendon causing irritation and inflammation.
The following speculative rationale is offered by proponents of an overuse theory of etiology: The extensor carpi radialis brevis has a small origin and does transmit large forces through its tendon during repetitive grasping. It has also been implicated as being vulnerable during shearing tresses during all movements of the forearm. While it is commonly stated that lateral epicondylitis is caused by repetitive microtrauma/overuse, this is a speculative etiological theory with limited scientific support that is likely overstated. Other speculative risk factors for lateral epicondylitis include taking up tennis later in life, unaccustomed strenuous activity, decreased reaction times and speed, and repetitive eccentric muscle contractions (controlled lengthening of a muscle group).
Conservative rehabilitation treatments such as chiropractic care and physiotherapy have been known to improve symptoms greatly while simultaneously removing the activities that irritate the median nerve. Regenerative medicine treatments such as PRP may also cause a natural decrease in inflammation as you undergo chiropractic care and rehabilitation.
By learning more about tennis elbow, we can better understand how to prevent and treat symptoms associated with it. When tennis elbow is present, whatever is required depends on the area affected and the symptoms present, and that is why it is important to have a team of doctors who can identify the root cause.
At BBC Health in Lewisville, Texas, we know how to identify, treat, or refer in the proper direction for any problems with your elbow. As a primary care provider, we can quickly provide medical, chiropractic, and rehab treatments to get you well as fast as possible. If you’re suffering from elbow pain, don’t delay, and contact us immediately to see how we can help.