What is Tennis Elbow?

The elbow joint is the point of articulation between the upper arm and the forearm. It is made up of

three bones, the humerus (upper arm bone) and the radius and ulna (the bones of the forearm).

The elbow joint is held together by ligaments, tendons and muscles, which all work in partnership

to provide mobility, stability, and strength to the elbow.

Your forearm muscles extend your wrist and fingers. Your forearm extensor tendons attach these

muscles to the bones in your elbow. The extensor tendons attach onto the bony bump on the

outside (lateral side) of the elbow (the lower part of your humerus) called the lateral epicondyle;

hence the condition also being known as lateral epicondylalgia. This is where the site of pain is.

The tendon usually involved in tennis elbow is called the extensor carpi radialis brevis (ECRB).

What causes Tennis Elbow?

• Unaccustomed activity and hand use, e.g. painting a fence, DIY, or excessive typing and mouse work.
• Activities or sports that involve excessive gripping.
• Muscle imbalances – weak forearm muscles or tight muscles.
• Poor stability and strength around the shoulder girdle.
• A poor technique i.e., a poor tennis or squash shot (usually back hand).
• Incorrect equipment i.e computer equipment, tennis/squash racquet or grip size.

Typically someone suffering from tennis elbow will experience pain when performing gripping tasks

or resisted wrist/finger extension such as lifting a kettle, gripping weight and playing sports. There

will be tenderness directly over the outside of the elbow over the bony epicondyle, and there may

also be painful points in the muscles along the forearm. Pain can be present when the forearm

muscles are stretched and some people may also have neck stiffness and tenderness. Most elbow

movements will be pain-free (unless gripping hard at the same time), despite that being the area of

pain.

The symptoms of tennis elbow usually begin to appear gradually, as the condition is a progressive

one, rather than related to an acute injury. As the condition progresses, the associated pain

gradually increases over the course of a few weeks or months.

Common signs and symptoms of tennis elbow:

• Ache or burning pain on the outer elbow, gradually increasing over time.
• Reduced grip strength.
• Usually affects the dominant arm.
• Pain worsens with sports or activities that require gripping.

Pain is often also felt while performing basic actions, such as writing or when gripping

small objects, lifting a kettle, turning a door handle or opening a jar.

Tenderness to touch on the bone and muscles on the outside of the elbow.

Swelling on the outside of the elbow.

Obtaining an accurate diagnosis of tennis elbow is essential. It allows the clinician to select the

most effective treatment plan for you. A diagnosis will be made by your physiotherapist who will

carry out a comprehensive subjective and clinical assessment. It is not essential at this stage to

have a scan.

They will ask questions about your past health, symptoms, and exercise regime, which will give

your clinician a good indication of your diagnosis.

After your consultation, the specialist physio will complete a series of tests to help confirm a

diagnosis. This may include:

• Assessing the range of movement and strength of your wrist, elbow, and shoulder.
• Assessing your grip strength.
• Measuring muscle length and flexibility of your forearm and upper limb.
• Checking other regions of the body as needed, such as your neck, back and shoulder. This

       will help to determine if other areas also require treatment to improve your condition.

       Gently, but skillfully, feeling around your elbow and forearm, to find exactly where it is most painful.

• Functional tests – if your pain is present during a specific activity or task, you may be asked to

       perform these, so the physiotherapist can assess exactly what is aggravating your pain.

       There is a specific test called the “Mills test” which is an accurate clinical test for diagnosing tennis

       elbow.

The clinical assessment is normally sufficient to diagnose tennis elbow. However, it is limited in

providing any further information about the exact structure of the tendon and surrounding tissues,

and the severity of the condition. This is where an ultrasound scan can be useful.

A real-time diagnostic ultrasound scan will help to confirm the diagnosis of tennis elbow, ascertain

the severity of the problem and to check if you have a tear in your tendon. It provides more detail

than an MRI.

An ultrasound scan is able to clearly visualise the tendon structure and inflammation associated

with tendinopathy. It is regarded as the gold standard imaging technique for assessing tendon

structure and pathology, better than MRI.

An ultrasound scan showing tendinopathy indicating tennis elbow. An ultrasound scan is better

than an MRI scan for visualising the tendon.

The scan allows for accurate assessment of the severity of the problem and can aid in treatment

selection. Once a full diagnosis has been made, your clinician will be able to discuss the most

effective treatment options with you.

Physiotherapy and rehabilitation for tennis elbow.

At the clinic we have treated a variety of patients with elbow pain, from Racing drivers, gymnasts to

recreational sports and women, and more sedentary individuals who get pain picking up objects.

Your physiotherapist at Chelmsford Physio will provide you with a personally tailored regime for

your tennis elbow, based on your clinical assessment.

Generic tennis elbow exercises, particularly those found on the internet do not help everyone! Your

programme must be tailored to your own personal goals. For example, the rehabilitation

programme for a professional tennis player will be different to a plasterer or brick layer, or

someone who wants to simply pick up the kettle or shopping bags with no pain.

This will often include:

Patient education – it is important to understand your condition and to be active in your recovery.

You will be given a clear explanation of the diagnosis, and we will discuss what is required to

address your symptoms and reach your goals.

Relative rest – advice on rest and activity modification allowing your elbow pain to settle and the

extensor tendon to heal. In severe cases, it might be that a wrist splint is required to allow the

forearm tendons to completely rest for a short period of time.

Pain management – ice applied to the affected area can be very effective in helping control pain

and inflammation. Over-the-counter medication such as painkillers and anti-inflammatories can

also ease pain and inflammation.

Specific loading/strengthening exercises – clinical research has shown that heavy slow

resistance (HSR) strengthening exercises can have a positive effect on tendinopathy. This is a key

component of your treatment programme and requires commitment and consistency. We are

specialists at exercise prescription and progression and will develop a bespoke programme for

you.