Tennis elbow is an inflammation of tendons that extend the wrist and fingers. This inflammation usually comes from overuse such as repeating the same motions over and over again. Unlike acute injuries, where a specific cause of pain can be identified, overuse injuries are subtle and occur over a period of time. They occur as the result of repetitive microtrauma to tendons, bones and joints.
There are four muscles that extend the wrist and fingers. The most common tendon affected is the extensor carpi radialis brevis (ECRB). The ECRB may also be at increased risk for damage because of its position. The muscles that extend the wrist and fingers attach to a bony bump on the outside of the elbow called the lateral epicondyle and travel town the forearm to the wrist and hand. As the elbow bends and straightens, the ECRB rubs against the epicondyle. This can cause gradual wear and tear of the muscle over time.
Symptoms of tennis elbow are pain on the outside of the elbow and a weak grip strength. Sensations such as pain and “pins and needles” can also travel down the forearm. Though this injury is traditionally called “tennis elbow”, symptoms can begin from performing many different activities. Pain and discomfort will typically occur with tasks such as swinging a tennis racket, turning a doorknob, or frequently using tools such as a screwdriver or hammer.
Physical therapy can be very beneficial for people with this injury. Tennis elbow is diagnosed through a description of the history of the symptoms and a physical examination. During the examination, a physical therapist will try to reproduce the symptoms in order to make a correct diagnosis. Range of motion and strength tests of the arm and wrist will be performed. Once a diagnosis is made then therapy will begin and a plan of care will be determined. Typical physical therapy sessions will include range of motion, exercise, manual therapy (such as deep friction massage), and neuromuscular reeducation. Rest, heat and ice are important and will help with pain relief. A strap may also be worn around the forearm near the elbow to provide some tension relief for the muscles.
Most people with tennis elbow will make a full recovery, provided that they attend physical therapy and follow instructions that are suggested by the therapist. If tennis elbow is not addressed early, it can continue to be painful for years. Tennis elbow is also prone to reoccurrence. Therefore the earlier one gets the proper medical attention, the faster the rate of return to activity. Once returning to activity, it is important to continue to stretch and perform exercises given by the physical therapist.
If conservative treatment is not successful new medical treatments such as platelet-rich plasma (PRP) injections may be an alternative option. A person’s own blood is used for a PRP injection. Blood is composed of mainly a liquid (plasma) with small solid components (red cells, white cells, and platelets.) Platelets are very important in the healing of injuries. PRP is plasma with many more platelets than what is typically found in blood. To help promote healing with tennis elbow, a person’s blood will be drawn and prepared through a special process that separates platelets from the blood. The increased concentration of platelets is then combined with blood again and injected into the affected tendon area. Physical therapy will continue to be an important and necessary aspect of the healing process as well as reoccurrence prevention after the PRP injection.