Tennis Elbow (Lateral Epicondylitis) Treatment in Delhi, India

Lateral epicondylitis is a form of overuse injury resulting in the inflammation and degeneration of tendons at the elbow region, causing pain and discomfort in the elbow and arm. These tendons are the bands of tough tissues that join the muscles of the forearm to the bone. This injury is not restricted only to tennis players; it can also affect other people. Any form of gripping or squeezing activity also worsens the injury. It commonly occurs among people above 40 years old. Lateral epicondylitis is also called 'Tennis Elbow'. Generally, it affects the dominant side of an individual, but in some cases, both arms can also be affected.

Tennis elbow can affect recreational and professional individuals equally. These include:

• Tennis players
• Baseball players
• Cricketers
• Golfers
• Fencers
• Squash players

Apart from players, individuals working in certain professions are more likely to develop this condition. These include:

• Musicians
• Dentists
• Chefs
• Butchers
• Gardners
• Automechanics

Tennis elbow is an overuse injury resulting from muscles getting fatigued, and the entire load is on the tendon. It leads to inflammation and pain and is termed tendinitis. Over time, this repetitive stress leads to degenerative changes in the elbow, known as tendinosis. Therefore, tendinitis, in addition to tendinosis, leads to tearing tendons in the elbow, resulting in lateral epicondylitis.

Symptoms of Tennis Elbow (Lateral Epicondylitis)

The symptoms of this condition develop over time and get aggravated by overuse. Pain may worsen from weeks to months and remains a prominent feature. Apart from pain, various other symptoms are as follows:

• Pain and stiffness while extending the arm.
• Tenderness around the forearm.
• Pain radiating from the elbow toward the wrist.
• Weakening of the grip.

Diagnosis of Tennis Elbow (Lateral Epicondylitis)

A thorough physical examination of the patient is done, followed by an assessment of the range of motion at the elbow joint to check for pain and tenderness. This is followed by imaging tests like X-ray and MRI scans to diagnose this condition and look for further damage to tendons and associated muscle fibers. Electromyography may also be done to look for any possible nerve compression.

Special Tests

• Cozen's Test: Cozen's trial is also called the resisted wrist extension test. The elbow is positioned and stabilized in 90° flexion. The therapist palpates the lateral epicondyle and, with the help of his other hand, places the patient's hand into a position of radial deviation and forearm pronation. Then, the patient is asked to perform wrist extension in a resisted manner. The test is positive if the patient encounters sharp, sudden, and severe pain over the lateral epicondyle region. High sensitivity and tenderness are often associated with positive results,  indicating the presence of lateral epicondylitis.
• Chair Test: In this test, the patient stands at the back side of the chair, and while standing behind the chair, they attempt to lift the chair with the help of a three-finger pinch, i.e., thumb, index finger, and middle finger, and the elbow is kept fully extended. The test is considered positive as soon as the pain is perceived at the lateral epicondyle. 
• Mill's Test: In this test, the patient is made to sit with the upper extremity relaxed at the side of a table, and the elbow is in an extended position. The therapist passively stretches the wrist, firstly in flexion and then in pronation. If the pain is felt at the lateral epicondyle area, it is considered a positive sign of lateral epicondylitis. 
• Maudsley's Test: The examiner performs a resisted extension movement of the hand's third finger while palpating the lateral epicondyle simultaneously. The test is positive if the pain is produced over the lateral epicondyle.
• The coffee cup test is performed during a particular activity, like grasping and lifting a full cup of coffee or a milk bottle. The patient is then asked to rate their level of pain based on a scale of zero to ten.

Treatment for Tennis Elbow (Lateral Epicondylitis)

Tennis elbow usually improves slowly on its own with conservative treatment. However, complete recovery may take up to 18 months. A few proven non-surgical techniques can accelerate recovery, including:

• Rest: The patient is advised to stop or reduce the activities for several weeks to give the tendons adequate time to heal.
• Icing the Elbow: It reduces pain and swelling around the elbow. The ideal way to do it is for 20 to 30 minutes, every 3-4 hours for 2 to 3 days or until the pain subsides completely.
• Nonsteroidal Anti-inflammatory Drugs (NSAIDs): NSAIDs may ease pain and inflammation.
• Braces: The doctor recommends wearing a removable elbow support brace called a tennis elbow support. This tool takes tension off the tendons and muscles and provides excellent support to the elbow.
• Physical Therapy: Physical therapy exercises reduce pain and inflammation and strengthen forearm muscles and grip. Massage, ultrasonic treatment, TENS, or other muscle-stimulating techniques help reduce pain and improve function.
• Laser Therapy: It is given to heal the tissues and the damaged tendons of the extensor carpi radialis brevis. 
• Steroid Injections: Corticosteroids relieve joint pain and inflammation temporarily. These injections must be administered in the correct area to achieve maximum benefit and given under the guidance of ultrasound.
• Platelet-rich Plasma (PRP) Therapy: Platelets are very small, tiny cell fragments in the blood that facilitate healing. During PRP therapy, the doctor extracts a small amount of blood and then separates platelets from other corresponding blood cells. Then, they insert the concentrated platelets into the target area under ultrasound guidance.
• Extracorporeal Shock Wave Therapy: Sound waves have the potential to break up scar tissue. Afterward, the blood flow to the involved area improves.
• Minimally Invasive Tenotomy: The doctor can conduct a minimally invasive procedure to remove degenerative tendon tissue inside the tendon. This procedure is called 'Tenotomy' and uses a needle device with high-pressured saline to create suction and hydro-resect the degenerative tendon tissue. This may be an alternative to a more extensive surgical procedure.
• Surgery: If the symptoms haven't improved after 6-12 months of extensive non-operative treatment, the patient is considered a candidate for surgery to remove the damaged tissue. These procedures can be performed through a large incision or several small incisions. Rehabilitation exercises are crucial to recovery post-surgery.

Prevention of Tennis Elbow (Lateral Epicondylitis)

• Slow down the activities of the forearm and hand while in pain, as it can further damage the tendons and associated muscles.
• Strengthen forearm and wrist muscles.
• Do warm-ups before indulging in any hectic work schedule.
• Wear tennis elbow support.

Approximately 95% of people with tennis elbow heal very well and respond to non-surgical treatments. Afterward, they can resume their routine life activities. However, it may take six to 18 months for the symptoms to subside completely. A small number of people need surgery.

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