Tennis elbow occurs when the wrist is used in sports or other activities and it is also called as humerus lateral (medial) epicondylitis. It is an inflammation at the insertion of the forearm extensor (flexor) tendon (the same as so-called tenosynovitis). It occurs most in playing tennis, followed by golf, badminton, kendo, and table tennis. It occurs not only in athletes, but also in those who engage in occupations that use the wrist, such as plumbers, cooks, and carpenters, and in kind of occupations holding heavy things.
Cause and mechanism of pathogenesis
Tennis elbow is caused by the occurring impact on the wrist at the moment of hitting the ball on the racket, and the stress extends to the insertion of the elbow muscle tendons. Compared to advanced players, beginners and intermediate players who are less likely to touch racket sweet spots tend to get injured, as it reflects “disorder due to unskillfulness of technique”. The underlying cause of injury is a fatigue disorder due to overuse.
The type of injury is broadly divided into a backhand type that affects the lateral side of the elbow (radial side) (Photo 1) and a forehand type that affects the medial side of the elbow (ulnar side) (Photo 2). The triggers include the material of the racket (quality of impact absorption), the hardness of the string, and poor impact absorption due to damage of the racket.
The extensor digitorum communis, which extends from the lateral epicondyle of the elbow, and the extensor carpi radialis brevis (longus), which dorsiflexes the wrist, are attached to the lateral epicondyle of the elbow, and the wrist’s motor impact is transmitted through the forearm to the elbow’s attachment site.
This symptoms include pain and tenderness over the elbow (lateral and medial) when gripping and moving the wrist. X-ray examination shows no abnormalities of the bones.
Magnetic resonance imaging (MRI) shows mild inflammation (hyper intensity).
Treatment and rehabilitation
In principle, the treatment is conservative one. Oral medicine and anti-inflammatory analgesic plaster are commonly used. When symptoms are severe, local steroid hormone injections are given, but be careful not to do frequently. Surgery is rarely performed.
It is helpful to do flexion and extension of the shoulder, wrist, and fingers, as well as rotational stretching of the forearm before and after exercise. Specifically, for right-handed players, traction of forearm pronation (Photo 1) and supination (Photo 2) with the left hand in the right elbow extension position stretches the hand-elbow-shoulder. Dorsiflexion stretching of the wrist may also be helpful. I would recommend that the patient does these stretching exercises in play.
Photo 1: Internal stretch
Photo 2: External stretch
Supports and Braces
Supports and braces (taping) are useful in impact absorption at the elbow and also required for wrist immobilization (Photos 3 and 4).
Strengthening the wrist muscles by training as well as the elbow is getting more important. When a patient has pain, stretching exercises can be done as a main component. After the symptoms have subsided, a plastic bottle (Photos 5 and 6), about 1 kg of dumbbells, or tubes can be used to perform dorsiflexion, palmar flexion, or rotation of the wrist while the elbow is firmly secured to avoid stress.
Photo 5: Training for elbow muscle strength
Photo 6: Wrist strength training
If there is no pain, the time for practice should be shortened to avoid overuse fatigue problems. In addition, make sure to take icing on the elbow after exercise (Photo 7).
Photo 7: Icing of the elbow
Backhand tennis elbow is decreasing in junior athletes because of the spread of two-handed stroke with bending the elbow. However, wrist disorders and medial elbow injuries are increasing due to rapid serves, smashes, and single-handed strokes with top-spin wiper swings. In the senior group, a large number of players are single-handed (with elbow extension) that leads to back-hand tennis elbows.
It is very common in the competitions with the instruments, as well as tennis using rackets that players tend to place more emphasis on techniques rather than enhancement of body flexibility. I have seen some athletes who are anatomically inflexible even in the top class at the medical checkup.
Results of a survey of 80,000 people about the longest-lived sports (2017, from the most authoritative British Journal of Sports Medicine).
The first place was tennis (racket sport) rather than running or swimming!
(the 2nd was running, the 3rd was cycling, the 4th was swimming and the 5th was aerobics)
Tennis is also associated with a low risk of cardiovascular disease!
Is it suggested that we had better continue some hard aerobic exercise such as tennis rather than walking?