Is the Pain in my elbow and lower arm Tennis Elbow?

By: Karen Graham VTCT GCP

S.P. Tyrer in his Pain Reviews, volume 6, 1 July 1999, pp. 155-166 published by Hodder Arnold Journals referred to the condition of tennis elbow in the following way. "Repetitive strain injury is mainly caused by abnormal postures and prolonged periods of work, changes in working practices and injuries associated with these working practices rather than the implied term of repetitive movement."

The correction of abnormal posture by undertaking, amongst other things, a program of graded exercises is a recognised treatment for tennis elbow and its sister condition golfer's elbow. This form of treatment is also noted for medial collateral ligament sprain and tendonitis. For issues concerning ergonomic design that are a factor in the deterioration of the condition alterations in working practice and in the working area need to be assessed.

The Anatomy of the elbow.

There are many muscles and tendons that make up the elbow joint along with the three bones that make up the structure of the arm: these bones are called the humerus, (upper arm) the radius and ulna (which are both bones of the lower arm). All three of these bones meet and are joined together at the elbow by ligaments in a hinged joint that allows the elbow to flex, straighten and the lower arm to turn slightly left and right. These movements are controlled by muscles whose tendons attach them to the bones.

a) Tendons are the end part of the muscle that has a higher fibrous content than the muscle itself.

b) The point of origin of a tendon is the stationary part of the movement.

c) The tendon attachments to the lower arm (radius and ulna) move and are known as the insertion points.

d) The arm flexes and extends at the elbow joint by these muscles, on both the front and back of the lower arm, lengthening and shortening

e) Movement at the elbow joint is achieved by the muscles pulling the bones closer together. The medial muscles, in the lower arm, pull the radius and ulna (2 lower arm bones) towards the humerus during flexion at the joint.

f) On the other hand the outside muscles, of the lower arm, pull the lower arm bones back in the opposite direction when the elbow joint is being extended. In a hinged joint the bones can only be returned to their original starting place.

Every day we are constantly using our arms, hands, wrists and shoulders. Normally these tendons glide smoothly over each other without us noticing their movements but this is not the case with tennis elbow.

What actually happens within our bodies when we have tennis elbow?

Nirschl and Pettrone in 1979 discovered the culprit for lateral epicondylitis. It was found that microscopic tears, in the tendon of the extensor carpal radialis brevis muscle was the cause of the pain and stiffness associated with the condition. They also noticed that instead of repairing these tiny tears failed to repair but increased in size to become macro tears which eventually caused the tendon to structurally fail.

The following progressive stages of the condition were defined by Nirschl as Stage 1 - reversible inflammatory changes

Stage 2 - Increased changes to the Extensor Carpal Radialis Brevis muscle tendon which have become non-reversible

Stage 3 -Extensor Carpal Radialis Brevis muscle tendon becomes ruptured

Stage 4 - Secondary changes such as fibrosis or calcification appear in the tendon.

Things that increase the risk of injury

Around 50% of all tennis players will get tennis elbow but of course this condition is not confined to just tennis players. Playing more than 2 hours constant play per week increases the incidence of lateral epicondylitis by 2 - 3 times and the risk is even greater for those over 40 by 2 - 4 times.

Improper playing technique, along with racquet weight and size of racquet handle have been shown to contribute to getting the condition

35-55 years has been shown to be the most common age bracket for a recreational athlete to suffer from an RSI injury. Other skilled workers and professional people such as carpenters, musicians and other sports people are also very prone to RSI injuries.

Besides tennis elbow there are other forms of RSI injuries that guitarists and other professions are particularly prone to getting and this includes conditions that produce pain and inflammation of the fingers, thumb joints, wrists and shoulders.

In order to avoid getting tennis elbow, golfer's elbow, bursitis, carpal tunnel syndrome or any other of the repetitive strain injuries, so prevalent in our society, it is imperative that we learn all about what we can do to prevent ourselves becoming just another medical statistic.

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