Treatment for tennis elbow- lateral epicondylitis, golfer's elbow, medial epicondylitis, medial collateral ligament sprain and tendonitis requires the correction of abnormal posture, a program of graded exercises, alterations in working practice and in the area of work if there are issues concerning ergonomic design.
The Anatomy of the elbow
There are many muscles and tendons that make up the elbow joint along with the three bones that make up the structure of the arm: these bones are called the humerus, (upper arm) the radius and ulna (which are both bones of the lower arm). All three of these bones meet and are joined together at the elbow by ligaments in a hinged joint that allows the elbow to flex, straighten and the lower arm to turn slightly left and right. These movements are controlled by muscles whose tendons attach them to the bones.
a) Tendons are made up of fibrous tissue.
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) It is these muscles, on both the front and back of the lower arm, that causes the arm to flex and extend at the elbow joint. This is done by pulling the bones closer together.
e) During flexion the inside muscles, of the lower arm, pull the radius and ulna forwards towards the humerus.
f) During extension the muscles at the back of the lower arm pull the bones back towards the humerus. (Fortunately for us once it gets to a certain point the bones will not move any further.)
Every day we are constantly using our arms, hands, wrists and shoulders. Normally these tendons glide smoothly over each other without us noticing their movements but this is not the case with tennis elbow.
What actually happens within our bodies when we have tennis elbow?
In 1979 Nirschl and Pettrone found that it was microscopic tears in the tendon of the extensor carpal radialis brevis muscle that was the culprit for causing lateral epicondylitis. They noticed that these tiny tears didn't repair properly but became macro tears (larger) which caused structural failure to the tendon.
Nirschl defined the following progressive stages of lateral epicondylitis as
Stage 1 - Inflammatory changes that are reversible
Stage 2 - Non-reversible changes to the tendon of the Extensor Carpal Radialis Brevis muscle
Stage 3 - Rupture of Extensor Carpal Radialis Brevis muscle tendon
Stage 4 - Secondary changes to the tendon such as fibrosis or calcification.
What can put you at risk of getting tennis elbow?
Around 50% of all tennis players will get tennis elbow but of course this condition is not confined to just tennis players. Playing more than 2 hours constant play per week increases the incidence of lateral epicondylitis by 2 - 3 times and the risk is even greater for those over 40 by 2 - 4 times.
Some of the risks that contribute to getting tennis elbow have been identified as raquet weight, size of the raquet handle and improper playing technique.
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 tennis elbow, golfer's elbow, bursitis, carpal tunnel syndrome or any other of the repetitive strain injuries, so prevalent in our society, it is imperative that we learn all about what we can do to prevent ourselves becoming just another medical statistic.
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