Tennis Elbow Flashcards
What is Tennis Elbow?
Tennis elbow, or lateral epicondylopathy, is a condition where the tendons on the outer side of the elbow become irritated or degenerated. It causes pain and weakness, especially during gripping or lifting activities.
What Causes Tennis Elbow?
It’s usually caused by repetitive strain or overloading of the tendons in the forearm, particularly the extensor carpi radialis brevis (ECRB) tendon. Activities like repetitive wrist extension or gripping are common triggers.
Where is the lateral epicondyle?
The lateral epicondyle is the bony prominence on the outer elbow where the extensor tendons attach.
What Questions Should Be Asked During the Subjective Assessment?
- Where exactly is the pain located?
- What activities make the pain worse? (e.g., gripping, lifting, or using tools).
- How long have you had symptoms? Did it start suddenly or gradually?
- Do you experience pain at rest or only during movement?
- Have you noticed any weakness in your grip strength?
Key Observations and Movements to Assess
- Look for tenderness at the lateral epicondyle.
- Assess wrist and finger extension strength for pain or weakness.
- Check grip strength with a dynamometer if available.
Cozen’s test?
The patient’s arm is in extension, the forearm in pronation, and the wrist in slight radial deviation. The examiner palpates the insertion of the extensor carpi radialis brevis muscle at the lateral epicondyle of the humerus. Then, the patient is asked to make a fist and to perform resisted wrist extension against pressure applied by the examiner.
The test is positive in case the patient’s familiar sudden lateral elbow pain is reproduced.
Mill’s Test?
To conduct the test, the patient is in standing or sitting position with the elbow in flexion. Use one hand to stabilize the forearm while palpating the lateral humeral epicondyle with the thumb. Then, passively pronate the forearm, flex the patient’s wrist and extend the elbow maximally.
This will place tension on the extensor carpi radialis brevis with the aim to exacerbate symptoms.
The test is positive in case the patient’s familiar sudden lateral elbow pain is reproduced.
Maudsley’s Test?
How to Perform: Resist the extension of the middle finger while the elbow is extended.
Positive Sign: Pain at the lateral epicondyle, indicating extensor tendon involvement.
Activities to Avoid with Tennis Elbow
- Avoid repetitive gripping or wrist extension, especially with heavy objects.
- Limit activities that cause sharp pain, such as lifting with the palm facing downward.
- Avoid prolonged use of tools or devices that require repetitive hand movements.
Early-Stage Exercises for Tennis Elbow
Isometric Wrist Extension
- holding small dumbel wrist over a table
Wrist Extensor Stretch
Gentle Grip Strengthening
(squeeze a ball)
What If the Patient Doesn’t Show Progress?
Reassess the diagnosis: Consider other conditions like radial tunnel syndrome or referred pain from the neck.
Check compliance with activity modifications and exercises.
Consider advanced treatments, like shockwave therapy, PRP injections, or referral for imaging if symptoms persist.
How a Tennis Elbow Brace Helps
When you grip or extend your wrist, the forearm extensor muscles contract, pulling on the tendon at the lateral epicondyle.
A tennis elbow brace applies pressure to the forearm muscles, acting as a “shock absorber” to reduce the force transmitted to the tendon at the lateral epicondyle. This creates a new pressure point on the muscle, redistributing strain away from the tendon, reducing irritation and pain, and allowing the tendon to heal by decreasing overload and inflammation.
The Brace as a “Shock Absorber”:
A tennis elbow brace applies pressure on the forearm muscles (about 1-2 inches below the elbow).
This compression reduces the force transmitted to the tendon by absorbing some of the stress before it reaches the tendon.
As a result, the tendon experiences less strain during movement, reducing pain and allowing it to rest and heal.
The brace creates a new pressure point on the muscle, essentially acting as a “false attachment point” for the tendon.
Instead of the tendon at the elbow taking all the stress, some of the force is redirected to the compressed area of the muscle.
This redistribution alleviates irritation at the actual tendon attachment site.
