The so-called “tennis elbow” corresponds to an inflammation that can affect anyone who performs repetitive movements with the forearm, wrist and hand.
A sharp pain, localized to the outside of the elbow, in a well-circumscribed point, which arises suddenly or more gradually and which can extend to the forearm and hand. It typically becomes more intense with arm movements, usually those performed more frequently at work, during physical activity or in home life. No obvious trauma at its origin, nor a degenerative alteration of the joint such as, for example, osteoarthritis.
This is the typical mode of presentation of the “tennis elbow”: it is an acute osteoarticular disorder, so called in common language in relation to the category of people that affects preferentially and almost inevitably at least once in a lifetime, but which can, in reality, affect anyone who uses the arm, wrist and hand in a repetitive way in the context of the most diverse tasks, resulting, in most cases, disabling for a few days.
Not neglecting the onset symptoms and treating this painful condition appropriately is essential not only to alleviate pain and limitation of movement in the shortest possible time, but above all to prevent the problem from becoming chronic, resulting in long-term discomfort, and to prevent possible complications that may require surgery to be resolved.
What is it
The term “tennis elbow” identifies an inflammation of the tendons that bind the humerus (the main bone of the “upper” part of the arm) to the elbow, more precisely called extensor tendons of the forearm. Not infrequently, in addition to acute inflammation, there are also microlesions affecting the fibers of one or more of these tendons, determined by their repeated, excessive or inadequate stress.
Since the tendons contain numerous nerve endings, any inflammation or structural damage (even very modest) to them results in acute pain, usually quite or very intense, to the point of preventing further movement of the joint on which those tendons are inserted (specifically, the elbow).
The medical term for tennis elbow is “humeral epicondylitis” or “lateral epicondylitis”. Sometimes, the term “epicondylitis” (used to identify the inflammatory phenomenon) can be replaced by “epichondallgia”, giving more emphasis to the symptom (pain) than to the inflammation that causes it.
Causes of tennis elbow
As mentioned, at the origin of tennis elbow there are excessive stress on the joint, repeated micro-lesions of the tendons that can result (tendinopathy) and the associated inflammatory phenomenon.
From the pathophysiological point of view, the type of movement at greatest risk is that which involves supination (ie the rotation of the forearm with the palm of the hand facing forward) and pronation (movement opposite to supination, which allows you to turn the palm of the hand downwards) repetitive and energetic forearm , as happens during the outward and upward rotation movements of the forearm and hand typical of the tennis “backhand” shot, which represents, by far, the most “critical” movement for the humeral epicondyle, the bony protuberance of the humerus at the elbow level. However, all activities involving similar dynamics and/or effort can lead to the onset of joint pain.
The development of inflammation and pain is more likely if the movement, in addition to being repeated, is also associated with an overload (supination and pronation of the forearm while holding a heavy object or having to force to move or turn something, such as a press, a steel pipe or a wrench) or a rapid / violent stress, Like the one inevitably connected to tennis rebuttals or, for example, to the weight throw in athletics.
Who can suffer
Being an acute inflammatory disorder determined by repetitive movements, in principle Anyone who performs such movements with an intensity and for a time greater than the ability of the articular structures to withstand the associated mechanical stresses may be affected by the tennis elbow. Regardless of gender, age and specific activity.
However, the people who most often complain of the symptoms of elbow tendinopathy are mainly adults, indifferently men and women, aged between 30 and 50 years. This peak incidence is not accidental, since at this stage of life the joint tissues begin to age and the tendons to become less elastic (therefore, more sensitive to stress and more likely to undergo micro-lacerations), while the average level of activity in the professional, sports or domestic field is very high.
Contrary to what one might think, in the category of sportsmen it is not professional or semi-professional athletes who develop tennis elbow more often, since their high technical preparation, constant and well-conducted training and, probably, also favorable constitutional characteristics and an overall healthy lifestyle (also in terms of nutrition), protect them from acute inflammation and micro-lesions at this level.
As frequently happens in the sport, Amateurs suffer the most from musculoskeletal damage and pain, such as those associated with humeral epicondylitis., who perform imperfect and unergonomic gestures, straining the tendons more than necessary and often well beyond their potential, also considering the occasional practice of the specific discipline and the lower strength and mass of the muscles that must move and keep the joint in axis.
With regard to sports activities at risk of inducing humeral epicondylitis, in addition to tennis, golf must also be remembered: In this case the disorder is added to the so-called “golfer’s elbow” or epitrocleitis, another inflammation of the elbow very common in those who practice this sport. In addition, fencing is also considered risky activities, many athletics specialties that involve throwing objects (weight, discus, javelin, etc.) and, more generally, all those disciplines that impose flexion-extension movements and rotation of the elbow and wrist, repeated and of a certain intensity (including some exercises for the arms that involve the use of weights).
The type of movements at risk of inducing humeral epicondylitis is also performed very commonly by those who carry out manual professional activities such as plumbers, carpenters, mechanics, painters, electricians, precision workers and watchmakers, as well as for those who deal with cleaning services, butchers, housewives etc. On the other hand, even those who carry out office jobs that require you to type for a long time on the computer are not immune to the disease, especially if a posture is maintained that does not allow tension to be released from the shoulders, forearms and hands.
Factors that favor tennis elbow
In those who play tennis in an amateur or semi-professional way, certain individual characteristics, playing habits or trivial errors in the execution of movements or in the choice of equipment can increase the risk of developing tennis elbow.
The main ones include:
– the presence of weak muscles in the shoulder and wrist;
– a too tight grip of the racket and / or a small handle compared to the size of the hand;
– hitting heavy balls (for example, wet) (for example, wet) (for example, with peripheral areas of the racket), imposing a greater effort on the elbow in the retort;
– the lack of a warm-up and stretching phase prior to the match or training on the field;
– the fact of playing for a long time or too intensely after a prolonged break period, without having foreseen a minimum athletic preparation.
Common symptoms and diagnosis
As mentioned, the As mentioned, , which at the beginning occurs when pressing on the area or when grasping an object since it is triggered mainly by the combined use of the muscles of the hand, wrist and elbow. From the epicondyle, the pain may extend to the middle part of the forearm.
If the disease is work-related, the pain is usually greater in the evening, while if it is related to sports activity it usually appears during or after a game or training, persisting for a variable time in relation to the extent of inflammation and tendon microtraumas present.
To have the Diagnostic confirmation Whether it is humeral epicondylitis, a Medical evaluation simple and fast, but not very pleasant, which consists of stress the inflamed tendon area with the so-called “provocation test”. Basically, to perform the test the doctor asks the patient to extend the middle finger of the hand while the arm is extended: if you feel pain along the course of the tendon of the common extensor it means that you suffer from tennis elbow.
An alternative maneuver used by the doctor to confirm the diagnosis is to sit the patient and make him rest his elbow (flexed), forearm and hand (with palm facing down) on the table top, then place his hand on that of the patient and ask the patient to lift his hand from the table, bending the wrist and exerting a force in opposition. If this effort determines the onset of tendon pain, it is tennis elbow.
The care of the tennis elbow
To alleviate inflammation and pain it is first necessary to limit or, preferably, suspend the activity that may have caused the tendinopathy, until the symptoms have completely regressed and you no longer feel any discomfort moving your arm.
You should not be in a hurry: To avoid experiencing new acute episodes in the short term, it is necessary to allow time for the tendon to self-repair the micro-lesions caused by repeated movements and to “strengthen”, leading to a complete healing.
So yes to rest, but not to immobility. It is always good to wait a few days and then resume the movement, being followed by a qualified physiotherapist who will suggest the right rehabilitation and training path.
Especially in cases of inflammation and more significant tendon injuries, to protect the elbow from improper movements that can be unintentionally performed in daily life, it is advisable to use a guardian: the orthopedist or physiatrist can indicate the most appropriate model and size on a case-by-case basis.
Another very useful and harmless immediate remedy to reduce symptoms is to apply ice or refrigerated bags on the elbow, for periods of 30-40 minutes, several times a day and during the night, when pain and inflammation appear more intense. In this regard, it should be remembered never to apply ice directly on the skin, but to always wrap the refrigerated bag in a soft cloth, to avoid cold burns.
In addition to these practical remedies, it is then possible to resort to common nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, ketoprofen, diclofenac or naproxen that have both analgesic and anti-inflammatory action, so as to combat inflammation and the pain that follows. That is why they represent the reference drugs for all pain syndromes of the osteoarticular apparatus, of a traumatic or degenerative nature.
Given the precise location of pain, Given the precise localization of pain, They can be found in the form of a cream or gel: in this way the active ingredient is administered on site and absorbed directly where it is needed.
This allows a targeted action of the drug at the level of the inflamed and painful site, also reducing side effects since only a minimal share of anti-inflammatory active ingredient reaches the general circulation.
The only important warning is to avoid exposure to the sun of the treated part in the days of application of the The only important warning is to , facilitating the development of erythema (to avoid problems, just wear a t-shirt or a long-sleeved shirt).
When analgesics, anti-inflammatories and rehabilitation gymnastics are not enough, you can try with the Shock wave treatment or you can make infiltration of corticosteroids or hyaluronic acid into the site of pain. However, these are obviously “extreme” solutions that are only considered following careful visits with a specialist.
In addition, it should be noted that steroidal anti-inflammatories should only be used in selected cases and with caution because they can weaken the tendons and facilitate their rupture. Only for the most severe manifestations and/or in case of recurrent episodes should surgery be considered.
How to prevent recurrence
After a first episode of humeral epicondylitis, if the activity that induced it is not almost definitively interrupted, It is quite likely that the disorder will recur after a certain time.
To prevent recurrence, it is advisable to undergo one or more cycles of physiotherapy and regularly perform the mobilization and strengthening exercises suggested by the physiotherapist at home, as well as remember to warm up the arm muscles before each sports commitment.
A simple elbow A simple to do at home is to stand, with your arms at chest height and your elbows slightly flexed, holding a rag or a small towel in your hands. The cloth should be squeezed first in one direction then in another, twisting wrists and elbows. The exercise should be repeated 5-10 times in a row.
To strengthen the extensor and flexor muscles of the elbow, however, the same rag / towel must be rolled up on itself (to transform it into a kind of wide rope) and, holding one end in one hand and the other in the other, with the arms at chest level opposing forces must be applied. That is: with one hand you must pull the cloth towards the torso by bending the elbow, while with the other hand you must push the other end of the cloth and stretch the elbow, moving the arm away from the torso. Also in this case the exercise should be repeated 5-10 times in a row.
A balanced diet has a certain role in protecting the health of the whole body and preventing a substantial number of diseases of various kinds, but It has a certain role in protecting the health of the whole organism and preventing a substantial number of diseases of various kinds, but
Trick | Purpose |
---|---|
Drink plenty of fluids | Ensure perfect hydration of the body and joint tissues |
Ensure an adequate supply of vitamins and minerals | Maximize the efficiency of muscle work |
Take Taking compounds compounds | Counteracting the aging of tissues (including tendons and cartilage) |
When to consult your doctor
The health of the elbow should never be neglected because it is a delicate and indispensable joint to perform many daily activities: the impossibility of using it easily can lead to a serious reduction in autonomy and quality of life. This also applies to an apparently trivial disorder such as tennis elbow, a pathology often linked to the wear of the joint, resulting from years of activity, which unfortunately can be accompanied by pain and a chronicization of the damage.
It is therefore It is therefore
If it is underestimated and the causes that caused it persist, in fact, the pain tends to become progressively more intense, until it causes a considerable functional impairment of the entire arm and hand. In addition, over time, In addition, with time, (very harmful to the entire joint), calcifications, the formation of bone growths (osteophytes) (very harmful to the entire joint), and, most importantly, degeneration of the tendons can occur.
To effectively resolve the acute episode and avoid these irreversible articular sequelae, it is advisable to contact the doctor from the first episode of acute elbow pain: this will allow you to obtain a precise diagnosis (excluding other possible pathologies at the origin of the pain) and competent advice on how to manage the situation with “home” remedies (ice, rest, etc.) and, above all, with the appropriate anti-inflammatory and analgesic drugs.
Joycelyn Elders is the author and creator of EmpowerEssence, a health and wellness blog. Elders is a respected public health advocate and pediatrician dedicated to promoting general health and well-being.
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