What is tennis elbow? Let’s find out about epicondylitis

Epicondylitis: what is “tennis elbow”?

More correctly, its name is lateral epicondylalgia, in fact, if until some time ago its etiology was considered inflammatory, recent scientific studies have shown that it is caused by a tendon degeneration resulting from repetitive use of the body district.

It is estimated that 1-3% of the population suffers from it: the typical onset is between 30 and 64 years, with a peak between 45 and 54.

Men and women suffer more or less equally, and the prevalence is higher among athletes (especially among non-professional ones, due to a not always excellent technique and inadequate preparation) and in some professional categories such as painters, plumbers, carpenters, watchmakers and those who use computers and mouses for most of the day. Responsible for the onset of epicondylitis are in fact – in most cases – the repeated extension and supination of the forearm and movements of the upper limb over the shoulder (as is typical of tennis, volleyball, handball, baseball , javelin throwing and body building).

Characterized by severe pain in the elbow, sometimes also radiating to the wrist and hand, epicondylitis must be diagnosed and treated promptly to prevent the symptoms from becoming chronic or worse.

Epicondylitis, how it alters the functionality of the limb

Epicondylitis, or humeral epicondylalgia, is a painful pathology of degenerative origin that affects the tendons that connect the forearm muscles to the lateral part of the elbow (lateral epicondyle).

Often called “tennis elbow”, it is not actually an exclusive pathology of tennis players or sportsmen in general: office workers who type on the keyboard or use the mouse all day long and a series of professional categories forced to repeat continuation of certain movements.

The primary cause is, in fact, a functional overload caused by the continuous and excessive use of the elbow.

The tendon wears out at the bone insertion level on the humeral epicondyle, and this creates painful symptoms in the elbow.

The patient feels pain, even very strong, due to the degenerative pathology which – if not treated – can get worse.

If at first it is only the tendons that hurt, especially in the execution of some movements, the symptoms can later spread to the hand and wrist, and can also be felt at rest.

Epicondilite: le cause

The first cause of epicondylitis is the repetition of a certain gesture: in fact, sportsmen and workers who continuously perform the same elbow movement suffer from it.

The tendon degenerates due to a functional overload, a repeated and excessive workload that leads to repeated microtraumas.

The repetition of simple movements such as typing on the keyboard or direct damage to the lateral epicondyle (an incorrect movement or excessive extension of the forearm) are risk factors for the development of this pathology.

You are more likely to have epicondylitis:

• who plays a racket sport (tennis, squash, badminton),
• who practices a throwing sport (discus throwing, javelin throwing),
• those who practice sports such as golf or fencing,
• workers who make repeated hand and wrist movements (bricklayers, plumbers, carpenters, cooks, butchers, tailors, painters),
• who repeatedly stresses the elbow and/or wrist (violinists, gardeners),
• who uses mouse and keyboard for many hours every day,
• who is between the ages of 30 and 50.

Epicondylitis, symptoms

The primary symptom of epicondylitis is elbow pain. Initially confined to the lateral epicondyle and limited to the movement phase (especially when the wrist is pushed against resistance), it can eventually radiate along the forearm until it reaches the wrist and hand.

The twisting movements of the forearm usually trigger the pain.

Sometimes morning stiffness may also appear as well as pain and weakness when lifting an object, even a very light one.

Epicondylitis usually affects the dominant arm, but it is not a fixed rule. The pain can be mild, moderate, or severe, and episodes can last between six months and two years (typical duration is 12 months).

Epicondylitis: the diagnosis

The patient who experiences constant and/or worsening pain in the elbow will contact the general practitioner who, after a thorough medical history and objective examination, will refer him to a specialist (usually an orthopedic surgeon).

During the visit, the duration and severity of the pain, the presence of any risk factors and the patient’s medical history will be examined.

The doctor will evaluate whether the pain may be due to movements made during work or sports, he will ask for the exact location of the pain, how it manifests itself during the day (if it gets worse when performing certain movements), he will evaluate the presence of other pathologies such as rheumatoid arthritis or neuritis.

It will then run a series of tests:

• palpation of the lateral epicondyle, asking the patient to move the elbow, wrist and fingers, so as to evaluate the presence of any swelling,
• Mills test, to detect the presence of pain on forced pronation with the wrist flexed and the elbow extended,
• Cozen test, to detect the presence of pain against the resistance of the wrist and fingers with extended elbow,
• Maudsley test, to detect the presence of pain on resisted extension of the middle finger.

The physical examination is usually sufficient to propose a diagnosis of epicondylitis, but the doctor may decide to prescribe further tests: an X-ray to exclude an inflammatory process of another nature at the elbow level and to check for the presence of calcifications, an MRI to rule out cervical arthritis or a herniated disc, an electromyography to rule out nerve compression.

Once all the necessary investigations have been carried out, the appropriate therapy can be started.

Epicondylitis, the therapies

In most cases, epicondylitis gets better with rest. Since the pain can persist for weeks or months, conservative therapies or, in the most serious cases, surgery are often prescribed.

Drugs

The acute phase of tennis elbow usually lasts no longer than 6-12 weeks.

However, if the pain is ignored, and the same movement continues, it can worsen and become chronic.

When it arises it is therefore essential to rest the joint for as long as possible, avoiding carrying out the activity that led to its onset.

Ice packs can be made several times a day, to soothe the pain and reduce inflammation, or painkillers can be taken as needed.

Different therapeutic avenues can be undertaken, depending on the goal that is set.

NSAIDs (non-steroidal anti-inflammatory drugs) are generally prescribed to be taken systemically or applied topically.

They are the drugs of first choice, since they have anti-inflammatory and analgesic properties, among these the most prescribed are: ketoprofen, ibuprofen, diclofenac and naproxen.

Pure analgesics such as paracetamol are not prescribed to treat the disease itself, but to reduce the painful symptoms associated with it.

In the most severe forms, infiltrations of corticosteroids such as methylprednisolone associated, or not, with lidocaine can be prescribed.

The treatments

In the case of severe and persistent epicondylitis, physiotherapy is recommended.

Joint pain and stiffness can be relieved by specific massages and manipulation techniques, but also by innovative treatments.

Among these we recognize:

• physiotherapy massage: the physiotherapist performs a deep transverse massage on the tendon insertions of the muscles involved. In general, the patient is explained exercises to be performed independently at home,
• shock waves: by directly hitting the inflamed muscle and the tendon structures that cause pain, they allow the problem to be solved in a few sessions (in the mildest forms),
• tecartherapy: carried out in resistive mode on the tendon insertions and in capacitive mode along the bands of the muscles involved, it reduces inflammation,
• high power laser: with an analgesic, anti-inflammatory and biostimulant effect, the best results, appreciable from the very first sessions, are guaranteed by the superpulsed laser and the Yag laser,
• kinesio-taping: helps reduce edema and congestion.

These techniques prove to be effective in the treatment of the acute phase.

The subacute phase should be treated with active strengthening exercises and the gradual recovery of functional activity, resuming activity under effort only in the absence of pain.

The final phase, on the other hand, involves resuming activity by increasing strengthening and resistance exercises.

The surgery

If in 6-12 months of conservative therapy the patient does not react to treatment, the specialist may consider surgery.

The operation involves the removal of the damaged tissue to relieve the painful symptoms, the partial disconnection of the extensor tendons of the wrist and fingers, scarification with local bloodying of the epicondyle.

The type of surgery (open or arthroscopic) is chosen on the basis of the severity of the problem and the patient’s clinical conditions.

The risks of surgery include:

• infection,
• loss of strength and flexibility,
• damage to nerves and blood vessels.

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