Q: Kindly guide about tennis elbow, my mother is suffering from the condition and cannot perform activities.
A: Lateral epicondylitis, often referred to as tennis elbow, is a common overuse injury resulting from repetitive strain on the common extensor tendon. This injury particularly affects the origin of the extensor carpi radialis brevis (ECRB) tendon, which is located at the lateral epicondyle of the distal humerus. The extensor muscles responsible for wrist and finger movements originate from this region, and repetitive strain or overload can lead to degeneration and inflammation, especially at the tendon’s origin. In many cases, the extensor carpi radialis brevis insertion is directly implicated, making it a central focus in both diagnosis and treatment.

A common misconception about tennis elbow is that it primarily affects tennis players. In reality, only about 5% of individuals diagnosed with this condition associate their injury with playing tennis. The primary cause is chronic contractile overload, which repeatedly stresses the tendon near its attachment to the humerus. This overload is common in activities requiring repetitive upper extremity movements. For instance, occupations that involve frequent manual tasks such as electricians, carpenters, gardeners, or office workers are particularly prone to developing this condition. Similarly, sports like squash, badminton, baseball, swimming, and field throwing events also frequently lead to tennis elbow due to the repetitive strain placed on the forearm muscles.

In everyday scenarios, activities such as computer use, heavy lifting, and frequent forearm pronation or supination can also contribute to the onset of tennis elbow. Continuous exposure to repetitive vibrations, such as those experienced in operating machinery or tools, can exacerbate the condition. This overuse leads to structural changes in the tendons, including hyaline degeneration, which weakens the tendon and results in pain around the lateral epicondyle.

The condition often progresses through distinct stages as described by Warren. These stages help in identifying the severity of the injury:

Mild Pain After Activity: Initially, individuals experience a faint pain a few hours after engaging in a provoking activity, such as playing sports or performing repetitive manual tasks.

Pain Following Activity: Pain becomes more noticeable at the end of or immediately after completing the activity.

Pain During Activity: Pain begins to occur while performing the activity, and it intensifies once the activity stops.

Constant Pain: In the most severe stage, the pain is persistent and prevents the individual from engaging in any physical activity.

These progressive stages highlight the importance of early recognition and intervention to prevent worsening of symptoms.

Tennis elbow often manifests with pain and discomfort that may radiate down the forearm, sometimes extending as far as the wrist and hand. Patients frequently report difficulty lifting objects or gripping, particularly when the elbow is extended. Grip strength weakness is a hallmark of the condition and is attributed to weakness in the finger extensors and supinator muscles. Some individuals may even describe a sensation of paralysis, though this is rare.

The onset of symptoms is typically delayed, occurring 24-72 hours after engaging in an activity that involves repetitive wrist extension or forearm movement. Factors such as changes in equipment or technique – like using a new tennis racquet, handling a wet ball, or overtraining – can trigger or worsen symptoms. Pre-existing issues such as shoulder injuries or poor biomechanics can also contribute to the development of tennis elbow.

Effective management of tennis elbow involves a multifaceted approach that addresses pain, restores function, and prevents recurrence.

to be continued...