
Tennis Elbow is a very popular form of acute tendonitis that is most prevalent in tennis players over 40. Up to 50% of racket sports players develop this condition at some stage. It is a degenerative condition where tendon fibres attach the muscles of the forearm to the elbow. Sufferers generally complain of a severe, burning pain on the outside of the elbow, which gradually worsens and is exacerbated by gripping or lifting things.
When treating tennis elbow, rest the area (meaning do NOT play racket sports) and apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for 1 to 3 days. Moist heat may be used after the acute swelling has improved and rest prevents further muscle injury. Ice reduces initial inflammation and swelling while the moist heat circulates blood through the area to speed the healing process. Accellarate healing with the use of ultrasound applications over the affected area as it reduces swelling quickly and increases blood flow to the area. If the patient gradually starts flexing and mobilising the area, the muscle may heal completely.
However, this is not what typical person does; they may ice once or twice and rest a bit, but most often just take some Advil or Tylenol then continue their racket sports. If the strain was minor their body may be able to heal the muscle fibers normally. Unfortunately, this is not the usual result because the injured muscle is being used instead of rested. Because of the stress on the muscle, their body heals the injured muscle fibers by binding them together with fibrotic adhesions (scar tissue). This is a normal defensive response, which prevents further damage to the injured area.
The patient should apply ultrasound treatment on the area up to three times daily. Ultrasonic energy naturally "works" the tendon, increasing its flexibily while softening and breaking down scar tissue; which is not something you want in your tendon. Scar tissue is inflexible (non-elastic), and can quickly lead to reinjury of the tendon down the road. If you choose to use steriod injections or are using steriod injections, do NOT treat the area with ultrasound until 30 days after the last injection. Steriod injections break down the tissue in the treated area in an attempt to get it to re-heal properly. Applying ultrasound over areas injected with steriods may increase the damage and can potentially tear the tendon.
The trick to any tendon injury is getting it to heal with minimal scar tissue formation and with as much realignment of tendon fibres as possible - something Ultrasound is great at! Even with optimum healing there is always less elasticity in a previously injured tendon. The trick is to make sure you heal this the best you can, that way your chance of reinjury down the road is much lower than average, which is well over 50%.
The most common cause of an tendon inflammation (tenosynovitis or tendonitis) is overuse of the affected tendon. Rest of the affected tendon is all that is required in some cases. Other treatments such as anti-inflammatory drugs or a steroid injection are sometimes needed. Infection of a tendon is an uncommon cause but needs treatment with antibiotics if it occurs.
Lateral Humeral Epicondylitis (Tennis Elbow)
Tendonitis
Tenosynovitis