Orthopedics-Online

Tennis elbow

Synonyms

Tennis elbow
Humeri radial epicondylitis
Lateral humeral epicondylitis
Mouse arm / mouse elbow

definition

Not only tennis players can suffer from this disease.

Tennis elbow is a disease from the orthopedic field. This term refers to inflammation of the tendon attachments of the extensor muscles of the forearm. The resulting scar tissue at the transition from tendon to bone then causes severe pain. The inflammation got its name from the fact that it was particularly common in tennis players in the past. In the meantime, however, this has changed as it is increasingly triggered by corresponding professions due to the increased work with computers and the mouse.

Epidemiology

The tennis elbow is a very widespread disease. It is mainly people between the 35 and 50 years of age affected, whereby the number of men somewhat predominates. Up to half of all tennis players will suffer from one at least once in their lifetime Tennis elbow.

Appointment with a tennis elbow specialist?

I would be happy to advise you!

Who am I?
My name is dr. Nicolas Gumpert. I am a specialist in orthopedics and the founder of .
Various television programs and print media report regularly about my work. On HR television you can see me every 6 weeks live on "Hallo Hessen".

As a former performance-oriented tennis player, I specialized early on in the conservative treatment of chronic tennis elbow.
In the last few years I have successfully treated several thousand tennis arms.

You can find me in:

Lumedis - your orthopedic surgeon
Kaiserstrasse 14
60311 Frankfurt am Main

Directly to the online appointment arrangement
Unfortunately, it is currently only possible to make an appointment with private health insurers. I hope for your understanding!
Further information about myself can be found at Dr. Nicolas Gumpert.

causes

There are various causes for a tennis elbow. The biggest role here is played by long-term mechanical overuse of the forearm and its muscles. This has a negative effect especially when they only one-sided exists (such as when using the mouse) or if it is accompanied by incorrect posture. When it comes to tennis, one thing leads the way wrong technique with the backhand for training a tennis elbow. Pre-existing diseases of the elbow such as osteoarthritis or fibromyalgia are discussed as further reasons. However, why a tennis elbow develops in some people with a corresponding risk profile and not in others cannot yet be conclusively explained.

Symptoms

The main symptom of tennis elbow is pain. Initially, they are usually limited to the protruding bone on the outside of the elbow and do not exist permanently, but mainly when pressure is exerted on this bone or the muscles whose tendons are inflamed is stressed. These muscles are responsible for stretching the hand. Therefore, the pain typically occurs during the following movements: the extension of the wrist or just the middle finger, especially if this extension is done against resistance, the turning of the forearm or the extension of the elbow when the hand is passively brought into a flexion position becomes. Closing a fist can also provoke pain.

Other tendons of the elbow can also be inflamed and cause similar complaints.
Read more about the Tendinitis in the elbow.

Over time, the pain usually gets worse and it can happen that it does not go away completely, even when the arm is completely at rest. In such an advanced stage, they often radiate far into the forearm.

In addition, the tennis elbow can cause weakness in the wrist, which can ultimately lead to a reduction in strength. As a result, the entire arm is functionally severely restricted, especially accessing it is extremely difficult. Everyday movements like shaking hands or even just picking up a pen can cause extreme pain for those affected. As a result, the quality of life is then often seriously affected.

Further information is available under our topic: Symptoms of tennis elbow

diagnosis

To make a diagnosis, a comprehensive medical history is important. Here the doctor should ask exactly what pain is present. This includes information on the type, frequency and localization of the pain, when it occurs preferentially, how long it lasts, whether it can be improved or worsened by certain activities, etc. It is helpful if the patient brings a pain diary with him to the doctor's visit he has noted these points over several days. This is particularly important because there are various diseases that are associated with pain that resembles that of a tennis elbow, including the golfer's arm, supinatorlogic syndrome, but also other inflammations or a tumor. However, the exact pain characteristics differ. In addition, various tests can be carried out: In the resistance test, the person concerned has to press his fist up or down against resistance, if pressure is exerted on the respective tendon attachments, the pain should increase, as well as when rotating the forearm or extending the middle finger.

Especially in order to differentiate the tennis elbow from other diseases, such as the golfer's elbow, but also osteoarthritis, it may be necessary to take an ultrasound or an X-ray. However, the x-ray does not show characteristic changes until relatively late in the course of the disease.

Further information is available under our topic: Diagnosis of tennis elbow

Figure tennis elbow

Spoke shaft -
Corpus radii
Ellschaft - Corpus ulnae
Upper arm shaft -
Corpus humeri
Long spoke side
Hand straightener -
Extensor muscle
carpi radialis longus
Shorter spoke side
Hand straightener -
Extensor muscle
carpi radialis brevis
Long thumb spreader -
Abductor pollicis longus muscle
Short thumb stretcher -
M. extensor pollicis brevis
Long thumb stretcher -
M. extensor pollicis longus
Elbow - Olecranon
Knobby Muscle - M. anconeus
Elbow side hand extensor -
M. extensor carpi ulnaris
Finger extensor -
Extensor digitorum muscle
Little finger extensor -
M. extensor digiti minimi
Extensor tendon strap -
Retinaculum musculorum extensorum

You can find an overview of all Dr-Gumpert images at: medical illustrations

therapy

As part of the therapy of tennis elbow, various measures can be taken, which should be based on the severity of the disease, the individual suffering and the wishes of the patient.

As a rule, conservative therapy is started. This means that one first tries to treat the tennis elbow without surgery. It is particularly important to protect the affected arm. Of course, the movement that caused the discomfort should be avoided, but other stresses on the arm should also be avoided as far as possible. The patient can easily improve pain himself with the help of cold or heat treatment, whereby the use of cold is particularly effective in the acute stage, while heat is particularly effective in the chronic stage. When cooling, care should be taken to ensure that the ice never comes into direct contact with the skin and that it is never cooled in one piece for more than 20 to 30 minutes.

Physiotherapy can also be useful. This includes certain stretching exercises that relieve pain and promote the healing process, as well as some special massage techniques, for example the transverse massage of the muscles of the wrist, which is also called transverse friction.
Treatment with locally applied ultrasound or microwaves can also reduce pain and can be used either alone or in combination with the massage in order to increase blood flow to the muscles before the massage. Similar, more controversial techniques are electro and shock wave therapy.
Further information is available under our topic: Shock wave therapy for a tennis elbow

There is also the option of applying a specific bandage, which is also called an "epicondylitis brace". This is a bandage that usually has to be worn for several days and takes the strain off the sore muscles and tendons. Other bandages or tapes can also be used to improve the symptoms.

The next step in the course of treatment is medication. Here, too, the doctor has different options, which are more or less effective depending on the case and should definitely be discussed with the patient before starting treatment. First of all, there are bandages that are soaked in ointments that contain anti-inflammatory substances, usually a cortisone preparation. As an alternative, such preparations can also be taken orally. There is also the option of applying a mixture of such anti-inflammatory drugs and local anesthetics to the affected muscle attachment.The anesthetic is injected around the nerves, thereby blocking the nerve conduction and preventing pain. In addition, classic painkillers are of course also used, especially from the group of anti-rheumatic agents (anti-inflammatory drugs). Alternatively, some herbal supplements, enzymes, nucleotides or drugs can also be used to relax muscles.

In some cases, acupuncture for tennis elbow also seems to be helpful, as it can not only reduce the pain, but also directly counteract the inflammatory reaction.

As one of the last measures, a patient with tennis elbow can be put on a forearm cast, which must be worn permanently and should prevent any movement in the joint. However, this is already a significant limitation for everyday life and therefore not a permanent solution.

If none of the above treatments bring any improvement in symptoms within 6 months, or if they even worsen under the therapy, an operation may be indicated. This only takes place in individual cases and must be carefully considered. An operation can normally be carried out on an outpatient basis and shows a good chance of recovery. Depending on the surgical technique, either the affected muscles are detached from their origin or the nerves that supply the corresponding area are desolated. Both can also be done together in a single procedure. A new option is minimally invasive surgery, in which only a very small skin incision is necessary, the operation only takes a few minutes and the risks are minimal. However, this technique is still fairly new and is not yet offered in many medical practices. After this mini-operation, the patient is immediately mobile again. According to the standard procedure, a cast must be worn for a certain period of time and the arm then slowly brought back to its normal load. Under certain circumstances, postoperative physiotherapy can also be useful.

In general, tennis elbow therapy shows very good success rates and patients can move freely again if they then conscientiously take measures to prevent a relapse.

Physiotherapy / physiotherapy

The choice of physiotherapy makes sense if those affected suffer from severe pain due to a tennis elbow both at rest and under stress.

Basically, physiotherapy has many different aspects.

A special method of physiotherapy is Transverse frictionwhich goes back to the English orthopedist James Cyriax (1904-1985). Local mobilization and pain relief play a central role here. With the help of this special transverse friction, a type of massage, it is possible to improve the local blood circulation and have a stimulating effect Mechanoreceptors exercise.

In addition, an increased tone in the muscles can be reduced by the transverse friction. If tendons have stuck together in the area of the elbow, this can also be resolved. It is also discussed whether the transverse friction can stimulate the formation of new longitudinal fibers.

Transverse friction is used both as monotherapy and in combination with cryotherapy. Cryotherapy is a type of cold therapy which, when applied locally, has an anti-inflammatory effect and stimulates blood circulation.

But not only cold can help - microwave therapy generates heat and is also often used for tennis elbow therapy. Microwave therapy is an electrotherapy that uses electromagnetic waves to generate heat in the affected muscles or tissue and thus has a pain-relieving, relaxing and metabolism-enhancing effect.

Exercises with a Thera-Band, a flexible rubber stick or vibration training with a fitness stick are being used more and more in physiotherapy. Functional muscle building also plays an important role.

Another approach in sports physiotherapy is to abandon incorrect techniques and optimize the framework. Incorrect warming up or stretching can also be reasons for the development of a tennis elbow.

As a physiotherapist, you should give those affected instructions on how to do stretching exercises correctly. Afterwards, the stretching exercises can be done independently in everyday life.

In addition to the various treatment options offered by physiotherapy, an ointment bandage with cortisone can be helpful to reduce the inflammation in the tennis elbow.

Acupuncture is also being used more and more frequently to treat tennis elbow.

The possibilities and forms of physiotherapy for tennis elbow are very extensive, which is why we have dedicated an entire topic to this form of therapy for tennis elbow.
More information is available at: Physiotherapy for tennis elbow

Taping

Taping is both a therapeutic and a prophylactic measure to treat or prevent tennis elbow.

The aim of taping is to have a positive effect on the muscles and to alleviate the symptoms (especially the pain).

There are currently different types of tape, some with different application methods. Most commonly used in tennis elbow therapy is the "Kinesio Tape", an elastic tape that was developed in Japan. The kinesio tape is made from a cotton base and has different colors depending on its elasticity and strength. In any case, the tape can adapt well to the skin surface of the arm due to its special nature.

To apply the kinesio tape, the patient should extend their arm and slightly bend their wrist. The attending physician or physiotherapist now sticks the tape to the back of the hand without exerting any tension. The tape is then attached along the forearm to just before the elbow while pulling. Here it is important to rub the kineso tape gently so that it adheres better to the skin. Rounding off the corners with scissors also improves adhesion.

In addition to the first tape, a second, slightly shorter tape with an inclined course is now attached. This runs from the upper outer area of the arm near the elbow to the inside of the forearm. It is important that this 2nd tape does not run through the crook of the elbow.

Ideally, the kineso tape should stay on the skin for a week in order to be able to develop its effect. This consists in

to reduce the pain
to relieve the muscle,
to ensure improved proprioception (body awareness),
to show decongestant effects
and also to optimize the lymph and blood flow.

As an alternative to the kinesio tape, there is also the inelastic leukoplast tape, which is not stretchable and has a relieving effect on tennis elbows and supports muscle work.

Finally, it should be mentioned that the therapeutic effect has not yet been significantly demonstrated in any study. Nonetheless, taping is an established method for the treatment and prophylaxis of tennis elbow.

Further information is available under our topic: Taping on a tennis elbow

surgery

Before a tennis elbow is operated on, all possible conservative therapeutic approaches should be exhausted. However, if the symptoms still do not improve after 6 to 12 months, further conservative therapy success is unlikely. Then the indication for surgical treatment is usually made. This is the case in 10-15% of tennis elbow patients.

The operation takes 40 minutes and can be performed on an outpatient basis. The operation is performed using 3 different techniques, sometimes in combination.

On the one hand there is the Hohmann operation, in which the tendon is removed from the Epicondyle (Protruding bone at the elbow) is loosened; one also speaks of one Decisions tenotomy. The incision is made transversely to the direction in which the tendon extends. The aim is to relieve the muscle tension through the incision in the tendon and to obtain a slight muscle lengthening.

A second technique, Wilhelm's operation, aims to prevent the transmission of pain sensation via the nerves. Therefore one desolates the nerve endings and separates them from their innervating muscles. This means that the pain stimulus can no longer be passed on and processed.

The two previous methods are mostly used as a combined technique.

The last operation according to Bosworth stands for the notching of the Annular radial ligament (ring-shaped spoke band). In the course of the operation, the joint capsule is opened and the corresponding fold of the synovium is removed if this was the reason for the pain of a tennis elbow.

Generally, at the beginning of the operation, the incision is made in an arc shape and about 5 cm long on the outside of the elbow. The fat layer and then the muscle fascia can then be severed.

Postoperatively, the tennis elbow has to be stabilized with an upper arm cast or bandage for 2 weeks. Apart from that, you are not restricted in any way after the operation (e.g. bed rest).

The pain is often very severe immediately after the operation, so that drug-based pain therapy is indicated. After about 12 days the stitches can be pulled. The arm does not need to be immobilized afterwards. Full strength is usually regained after 6 weeks. Although it is not absolutely necessary, it is advisable to bandage the arm after an operation in the event of future stress. Overall, the cure rate is 90%.

As with any surgery, there are certain risks to keep in mind. These include wound healing disorders, bleeding and inflammation. During wound healing, scar tissue also forms, which unfortunately can irritate the nerve endings after being severed (Wilhelm's operation) and thus cause pain. Another risk, which is less common and not specific to tennis elbow surgery, is the occurrence of "Complex Regional Pain Syndrome" (= complex regional pain syndrome, CRPS).

The phenomenon of the irregular healing process of soft tissue is also known as Sudeck syndrome and is a chronic neurological disease with sensory and motor disorders such as muscle weakness, burning pain at rest and hypersensitivity.

Apart from the surgical method explained so far, the trend is towards minimally invasive surgery (MIS). In contrast to 5 cm, the incision is only 1 cm long, so the remaining scars are smaller and less noticeable.

In summary, the operation of a tennis elbow can be classified as uncomplicated and promising to heal.

Further information is available under our topic: Operation of a tennis elbow

Bandage, brace, cuff

Bandages, braces or cuffs are effective aids for improving symptoms and for regulating the disturbed muscle tension in tennis elbow.

The use of a bandage affects the muscles as well as the tendons and ligaments. The muscles can be stabilized by wearing such a bandage and supported in their work. Furthermore, the tension changes mainly on the tendons of the corresponding muscles. By reducing the tension, there is some relief and pain relief.

Wearing a bandage has the advantage that mobility is maintained despite the stabilization and that you are not restricted in everyday life. As a rule, the bandages are relatively elastic and some of them have a silicone pad on the inside and outside. This silicone insert has a selective, massaging function. At the same time, wearing a bandage prevents inflammation.

In addition to the good wearing comfort, stabilization and pain relief, a big plus point of the bandages is that the arm is not completely immobilized and muscle work is preserved. In the case of the no longer used variant of a plaster of paris, this was a major disadvantage in that the stabilizing effect was always accompanied by muscle wasting. Therefore the forearm cast was never a permanent solution.

The bandages, epicondyle braces or cuffs, however, can be worn indefinitely; it is best to wear them for a few hours for several days. The bandage does not have to be taken off during sporting activities, but you can benefit from the positive effect on the muscles, tendons and ligaments even under stress.

The success or the response to therapy with a bandage can generally vary and depends on the individual condition of the individual person.

Further information is available under our topic: Bandage for a tennis elbow

stretch

Stretching plays an important role in the therapy of tennis elbow, as it is a good alternative to combating pain in addition to some other methods such as taping, bandage and physiotherapy.

One of the problems with a tennis elbow is that the tendons involved are shortened, which leads to pain.

With the help of various stretching exercises, it is possible to counteract this shortening. Further goals are to relax the muscles, to "make them supple" and to lengthen the tendons.

So it makes no sense to keep the affected arm still when you have pain from tennis elbow, as this will keep the shortening of the tendons and possibly worsen it.

The stretching exercises can be performed several times a day in the acute phase. Later it is a good idea to stretch before and / or after the exercise. Doing stretching before exercising can reduce the risk of torn muscle fibers.

One stretching variant is carried out as follows: You straighten your arm in the elbow joint and turn the inside of the forearm so that it points upwards or forwards. Then you bend your wrist and use the fingers of the other hand to push the already bent wrist backwards. You can feel a pull in your hand and forearm. The position should be held for 15-30 seconds and then slowly released. Over time, you become more and more flexible, so you should be careful not to stretch too much at the beginning.

As an alternative to this stretching exercise, you can also hang from a pole. It should be noted that you only hold on with your hands and that the arm muscles remain loose.

Further information is available under our topic: Stretching exercises for a tennis elbow

prophylaxis

In order to prevent a tennis elbow, it is important to avoid sports activities that could overload the forearm, such as tennis or badminton, warm up well and the To stretch muscles. In addition, one-sided stress in everyday and professional life should be avoided as far as possible.

Summary

The pain syndrome "tennis elbow" is a very common disease that is mainly caused by the Overuse of the forearm extensor muscles (or the resulting inflammation of your tendon attachments on the muscle) is triggered by working too long with the computer mouse. However, if you pay attention To make movements more varied and avoids one-sided stress, this disease can be prevented quite well. At the first sign you can go through a Immobilization of the arm and the Adjusting the pain causative activity to ensure that no chronic picture of a tennis elbow develops, which would make physiotherapy or in the worst case even an operation necessary.

forecast

The The prognosis of the tennis elbow is very good. In the vast majority of cases, this disease can be completely cured by conservative therapy alone. An operation is only very rarely necessary, but with very few exceptions it is completely free of symptoms.