Anatomy: Tennis Elbow (Lateral Epicondylitis) is inflammation to the wrist extensor tendons that originate from the lateral epicondyle of the elbow. The wrist extensors associated with tennis elbow are comprised of the following muscles: extensor digitorum, extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, extensor digiti minimi, and supinator.
Causes: This is typically an overuse injury that causes small tears to the wrist extensor tendons near the origin of the muscle at the elbow. This injury is common among painters, plumbers, construction workers, cooks, and those that spend a lot of time at a computer. It’s mostly due to repetitive twisting at the wrist or sustained wrist extension. We also see this injury more often in athletes who participate in racket sports due to poor form or overuse.
Signs and Symptoms: Sharp lateral elbow pain with movement at the wrist or upon palpation that progressively will worsen if untreated. Reduced grip strength and stiffness of the wrist will also accompany this condition.
Diagnosis: Diagnosis of tennis elbow is typically clinical in nature, meaning there is no need for expensive imaging tests. By testing wrist strength, palpating the elbow, and moving the wrist/elbow we are able to diagnose tennis elbow.
Treatment (Non-Surgical): Physical therapy is usually recommended as the first line of treatment for tennis elbow. The treatment protocol will include gentle stretches at the wrist, activities to increase range of motion of the wrist/elbow, gentle strengthening of the hand, wrist and elbow. Modalities such as ice, electrical stimulation, phonophoresis, or iontophoresis can be used to help reduce pain and inflammation in the tendon. Over the counter non-steroidal anti-inflammatories will help as well. If symptoms persist, your orthopedist may recommend a steroid injection into the tendon to decrease inflammation. If people are unable to stop doing aggravating activities, we recommend a brace (worn around the elbow) which helps compress the tendon and decrease pain while performing repetitive motions.
Surgical Treatment: When symptoms persist longer than 6 months and other treatments have been unsuccessful, then surgery may be required. Surgery is usually performed as an outpatient procedure and done in an open manner or arthroscopically. An open procedure consists of one larger incision that is made along the lateral border in order to expose the injury site. An arthroscopic procedure is where 2-3 very small incisions are made and tiny instruments are then used to perform procedure. Patients are usually sent home the same day and usually do not require an overnight stay. Rehab will then take place post-surgery. The surgeon will tell you when it’s safe to return to sports, which is usually not until 4-6 months post op.
Ulnar Nerve Entrapment
Also known as Cubital Tunnel Syndrome
Description: This occurs at the level of the elbow where the ulnar nerve travels through a tunnel and can be compressed. The ulnar nerve is one of the three main nerves that go to the hand. We have already discussed the median nerve that can be compressed in carpal tunnel. You may have banged your elbow before and have a shooting sensation down to the fingers and they call it “hitting your funny bone”, that is the area where the ulnar nerve is superficial at the elbow. This nerve goes to very important muscles that provide strength and dexterity in the hand and also sensation to the little finger and half of the ring finger. Although the ulnar nerve can get compressed in the hand or under the collarbone it most commonly occurs at the elbow.
Risk Factors: You would be predisposed to this condition if you have had a prior fracture around the elbow, bone spurs or inflammatory joint condition, such as RA that causes swelling around the joint or if you do repetitive activities such as bending and straightening the elbow or put pressure on the elbow for a long period of time. Pressure on the ulnar nerve can give the feeling of falling asleep of the little finger and half of the ring finger. The sensation is similar to carpal tunnel but on the other side of the hand. As the condition progresses often times weakness in the hand and difficulty with finger coordination can occur.
Prevention: Prevention and treatment are very closely related. In order to prevent this from reoccurring or treat it once it has occurred, avoid frequent use of the arm with the elbow in a static bent position and avoid repetitive bending and straightening of the elbow. If you are sitting at a computer, make sure that the chair is not too low so you don’t have to bend your elbow too much when using the computer. Avoid leaning on your elbow and putting pressure on the nerve. Try to keep the elbow straight during the day and especially at night when you are sleeping by using a splint or if you can position yourself and stay in that position that may work well. Sometimes in physical therapy we give splints for sleeping at night and also an elbow pad that will relieve the pressure if you put the elbow down on a hard surface. If no treatment is helpful, you may undergo surgical release of the cubital tunnel, which involves surgery at the elbow in taking the top off of the cubital tunnel and release of ligamentous tissue to prevent compression. Physical therapists may see patients post op to help restore mobility and strength and return people to their previous work and leisure activities.
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