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Tennis Elbow- What is it?

Jun 29, 2008
S.P. Tyrer in his Pain Reviews, volume 6, 1 July 1999, pp. 155-166 published by Hodder Arnold Journals referred to the condition of tennis elbow in the following way. "Repetitive strain injury is mainly caused by abnormal postures and prolonged periods of work, changes in working practices and injuries associated with these working practices rather than the implied term of repetitive movement."

The correction of abnormal posture by undertaking, amongst other things, a program of graded exercises is a recognised treatment for tennis elbow and its sister condition golfer's elbow. This form of treatment is also noted for medial collateral ligament sprain and tendonitis. For issues concerning ergonomic design that are a factor in the deterioration of the condition alterations in working practice and in the working area need to be assessed.

The Anatomy of the elbow.

The elbow joint is made up of many muscles and tendons. These along with the three bones (humerus, radius and ulna) make up the structure of the arm. All of these bones meet together at the elbow and are joined together by ligaments to make a hinged joint that allows both the flexion and extension of the lower arm and the additional movements of it to turn slightly left and right. Muscles are attached to these bones by fibrous tissue known as tendons which help to control their movement.

a) Extending out of the muscle, at either end is the tendon that has a higher fibrous content than the muscle itself. This allows for the stability of the muscle

b) The tendon attachments to the upper arm (humerus) are stationary and are known as the point of origin.

c) The tendon attachments to the lower arm (radius and ulna) move and are known as the insertion points.

d) Through the action of lengthening and shortening the muscles at the front and back of the lower arm the elbow flex and extend at the elbow joint.

e) Movement at the elbow joint is achieved by the muscles pulling the bones closer together. The medial muscles, in the lower arm, pull the radius and ulna (2 lower arm bones) towards the humerus during flexion at the joint.

f) On the other hand the outside muscles, of the lower arm, pull the lower arm bones back in the opposite direction when the elbow joint is being extended. In a hinged joint the bones can only be returned to their original starting place.

Every day the tendons in our arms, hands, wrists and shoulders constantly glide smoothly over each other and it is only when there is a problem that we give them any thought.

What actually happens within our bodies when we have tennis elbow?

The culprit for causing lateral epicondylitis was found by Nirschl and Pettrone in 1979. They discovered microscopic tears in the tendon of the extensor carpal radialis brevis muscle was causing the pain and stiffness associated with the condition. They noticed that tiny tears in the tendon failed to repair properly becoming macro tears which eventually caused structural failure to the tendon.

Using the following steps Nirschl defined the progressive stages of the condition as Stage 1 - Inflammatory changes which are reversible.

Stage 2 - Increased changes to the Extensor Carpal Radialis Brevis muscle tendon which have become non-reversible

Stage 3 - The Extensor Carpal Radialis Brevis muscle tendon becomes ruptured.

Stage 4 - Secondary changes such as fibrosis or calcification appear in the tendon.

Activities and other increased risk factors

Even though around 50% of tennis players will get tennis elbow at some time this condition is not just confined to tennis players. It is important to note that as a none professional playing more than 2 hours constant play per week increases the incidence of lateral epicondylitis by 2 - 3 times with the risk being greater for those over 40 by an increase of 2 - 4 times.

Improper playing technique, along with racquet weight and size of racquet handle have been shown to contribute to getting the condition

A typical person most likely to fall in to the age bracket for tennis elbow is between 35-55 years of age and who is either a recreational athlete or a person who does a lot of rigorous activity on a daily basis. Carpenters, musicians and other sports people are also very prone to getting lateral epicondylitis.

Besides tennis elbow there are other forms of RSI injuries that guitarists and other professions are particularly prone to getting and this includes conditions that produce pain and inflammation of the fingers, thumb joints, wrists and shoulders.

In order to avoid getting repetitive strain injuries such as tennis elbow, golfer's elbow, bursitis, carpal tunnel syndrome that are now so prevalent in our society, it is imperative to find out what we can do to prevent ourselves becoming just another unfortunate statistic.
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