Understanding Tennis Elbow: Causes, Symptoms and Treatment

Maria Carmela L. Domocmat, RN,MSN
Instructor
School of Nursing
Northern Luzon Adventist College
Artacho, Sison, Pangasinan

Overview
Part 1: Degenerative & Part 3: Muscular disorders
Metabolic bone disorders Muscular dystrophy
OA Rhabdomyolysis
Gout and gouty arthritis Part 4: Disorders of the
Osteoporosis hand
Paget’s dse Carpal tunnel syndrome
Osteomalacia Dupuytren’s contracture
Part 2: Bone infections Ganglion
Osteomyelitis
Septic arthritis

3/5/2012 Maria Carmela L. Domocmat, RN, MSN 2

Overview
Part 5: Spinal column Corn
deformities Callus
Scoliosis Ingrown Nail
Kyphosis Hypertrophic Ungual Labium
Lordosis
Osteogenesis imperfecta (OI) Part 7: Sports Injuries
Sprain
Part 6 : Disorders of foot Strain
Hallux valgus (bunions) Tennis elbow
Morton’s neuroma (plantar Impingement and rotator cuff
neuroma) tears
Hammer toe Knee injuries (ACL injury,
Tarsal tunnel syndrome meniscal injury, overuse
syndrome)
Plantar Fasciitis


Sports Injuries
Sprain
Strain
Tennis elbow
Impingement and rotator cuff tears
Knee injuries (ACL injury, meniscal injury, overuse
syndrome)


Sprain
A sprain is a stretched or torn ligament.
Ligaments are tissues that connect bones at a joint. Falling, twisting, or getting
hit can all cause a sprain.
Ankle and wrist sprains are common. Symptoms include pain, swelling,
bruising and being unable to move your joint. You might feel a pop or tear
when the injury happens.
A strain is a stretched or torn muscle or tendon. Tendons are tissues that
connect muscle to bone. Twisting or pulling these tissues can cause a strain.
Strains can happen suddenly or develop over time. Back and hamstring muscle
strains are common. Many people get strains playing sports. Symptoms include
pain, muscle spasms, swelling and trouble moving the muscle.
At first, treatment of both sprains and strains usually involves resting the
injured area, icing it, wearing a bandage or device that compresses the area,
and medicines. Later treatment might include exercise and physical therapy.
NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

http://www.nlm.nih.gov/medlineplus/sprai
nsandstrains.html

http://www.mayoclinic.com/images/image_
popup/mcdc7_anklesprain.jpg

Ankle sprain
An ankle sprain is a common injury to the ankle.
The most common way the ankle is injured is when
the ankle is twisted inward (inversion injury).
With this injury, ligaments that support the ankle can
be torn which lead to swelling, inflammation, and
bruising around the ankle.
An ankle sprain injury may take a few weeks to many
months to fully heal.

http://www.nlm.nih.gov/medlineplus/ency/
imagepages/19577.htm

The most common way the ankle can be injured is by
an ankle sprain.
When an ankle is sprained ligaments on the ankle are
either stretched, partially torn or completely torn.
The most common type of sprain is an inversion
injury, where the foot is rotated inward.

presentations/100209_4.htm

Ankle sprains can range from mild, to moderate, and
severe.

Type 1 ankle sprain is a mild sprain. It occurs when the
ligaments have been stretched or torn minimally.


Type II ankle sprain is a moderate level of sprain. It
occurs when some of the fibers of the ligaments are
torn completely.

Type III ankle sprain is the most severe ankle sprain.
It occurs when the entire ligament is torn and there is
great instability of the ankle joint.

Minor injuries like sprains may be treated at home if
broken bones are not suspected.
The acronym RICE is helpful in remembering how to treat
minor injuries:
"R" stands for rest,
"I" is for ice,
"C" is for compression,
"E" is for elevation
Pain and swelling should decrease within 48 hours, and
gentle movement may be beneficial, but pressure should
not be put on a sprained joint until pain is completely gone
(one to several weeks). http://www.nlm.nih.gov/medlineplus/ency/imagepages/
19396.htm

Strain

images/ency/fullsize/19618.jpg

Lateral epicondylitis
Epitrochlear bursitis
Tennis elbow

Lateral epicondylitis
inflammation, soreness, or pain on the outside
(lateral) side of the upper arm near the elbow.
There may be a partial tear of the tendon fibers, which
connect muscle to bone. The tear may be at or near
where these fibers begin, on the outside of the elbow.

Causes, incidence, and risk factors
Tendon - part of the muscle that attaches to a bone
Muscles in forearm attach to the bone on the outside
of elbow.
When these muscles are used over and over again,
small tears develop in the tendon.
Over time, this leads to irritation and pain where the
tendon is attached to the bone.

Causes, incidence, and risk factors
common in people who play a lot of tennis or other racquet
sports, hence the name "tennis elbow."
Backhand is the most common stroke to cause symptoms.
However, any activity that involves repetitive twisting of
the wrist (like using a screwdriver) can lead to this
condition.
Common among
painters, plumbers, construction workers, cooks, and
butchers are all more likely to develop tennis elbow.
This condition may also be due to constant computer
keyboard and mouse use

Tennis elbow is most commonly seen in two groups of
people:
Manual Laborers
People who work with their hands are at greater risk of
developing tennis elbow. Jobs that may lead to tennis elbow
include plumbers, painters, gardeners, and carpenters.
Sports Participants
Sports participants, especially racquet sport players, are prone
to developing tennis elbow. About a third of amateur tennis
players experience tennis elbow at some point in their careers.
In addition to racquet sports, tennis elbow is seen in golfers,
fencers, and other sports participants.

Symptoms
Elbow pain that gradually worsens
Pain radiating from the outside of the elbow to the
forearm and back of the hand when grasping or
twisting
Weak grasp
Pain over the outside of the elbow
Pain when lifting objects
Pain radiating down the forearm

Dx
diagnosis is made based on signs and symptoms,
because x-rays are usually normal.
Often there will be pain or tenderness when the
tendon is gently pressed near where it attaches to the
upper arm bone, over the outside of the elbow.
pain near the elbow when the wrist is extended (bent
backwards, like revving a motorcycle engine) against
resistance.
X-rays are rarely needed.

Treatment
Rest arm
avoid the activity that causes symptoms for at least 2 -
3 weeks.
Put ice on the outside of elbow 2 - 3 times a day.
NSAIDs ( ibuprofen, naproxen, or aspirin).

If due to sports activity
Ask about any changes can make in technique.
Check any sports equipment client is using to see if any
changes may help.
Ask about how often client have been playing and
whether he/she should cut back.

occupational therapist
can show exercises to stretch and strengthen the
muscles of forearm.
special brace for tennis elbow
It wraps around the first part of forearm and takes some
of the pressure off the muscles.
cortisone injection
If the pain continues after 6 - 12 months of rest and
treatment - surgery may be recommended

Surgical tx
debridement of the diseased tissue of the extensor
carpi radialis brevis (ECRB) muscle with decortication
of the lateral epicondyle.
performed through open, percutaneous, and
arthroscopic approaches.

http://orthoinfo.aaos.org/figures/A00068F01.jpg

Expectations (prognosis)
Most people improve with nonsurgical treatment.
The majority of those who do have surgery show an
improvement in symptoms.

Complications
Failure to improve with nonsurgical or surgical
treatment. This may be due to nerve entrapment in the
forearm
Recurrence of the injury with overuse
Rupture of the tendon with repeated steroid injections

Prevention
Apply an ice pack to the outside of the elbow
Maintain good strength and flexibility in the arm
muscles and avoid repetitive motions
Rest the elbow when bending and straightening are
painful

http://www.tennis-elbow.net/images/tennis-elbow-cure.gif

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH00
01485/

ACL Injury
Meniscal Injury
Overuse Syndrome


Overuse syndrome
is a condition where a part of the body is injured by
repeatedly overusing or exerting to much strain on that
body part.
The term overuse syndrome identifies a large group of
conditions that result from using the body in a repetitious
way and causing injury by the amount it is done.
These conditions are often focused on a joint and usually
affect the muscle, bone, tendon or bursa of the joint.
However other anatomical features and areas can be
stressed and their response to that strain can be an injury.


Some common examples of overuse syndrome are:
Carpal Tunnel Syndrome
Tendonitis
Bursitis
Tennis Elbow
Trigger Finger
Blackberry Thumb
Vibration White Finger
Shin Splints
Calluses
Bunyan


Bursitis
A bursa is a fluid filled sac. They are located around
joints and reduce friction and ease movement as
tendons or muscles pass over bones or skin.


Understanding Tennis Elbow: Causes, Symptoms and Treatment

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