Tennis Elbow
(lateral epicondylitis)

Tennis Elbow is a very popular form of acute tendonitis that is most prevalent in tennis players that are over 40 and 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), apply ice for 10-20 minutes at a time for at least 3 times a day. Do this to the injured area for the first day to 3 days. Moist heat may be used after the acute swelling is improved and rest prevents further muscle injury. Ice will reduces initial inflammation and swelling and the moist heat circulates blood through the area to speed the healing process. This can be further helped by 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 starting flexing and mobilising the area, the muscle would probably heal totally back to normal.

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 and continue to commence 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 or scar tissue. This is done in an attempt to prevent further damage to the injured area. It is a normal protective response of their body.

To prevent this the patient should apply ultrasound treatment on the area up to three times daily. Ultrasonic energy will naturally "work" 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 later 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 radiant energy and ultrasound are 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.

What is tenosynovitis and tendonitis?

* Tendonitis means inflammation of a tendon. (It is sometimes spelled as tendinitis.)
* Tenosynovitis means inflammation of the sheath that surrounds a tendon (the sheath is called the synovium). Tenosynovitis can be caused by calcium deposits, repeated strain or trauma, high levels of blood cholesterol, rheumatoid arthritis, gout, or gonorrhea.
These two conditions often occur together.

Never use Ultrasound over an area injected with a steroid (ie. cortisone) for at least 30 days.

Never use Ultrasound after surgery until your physician recommends and approves of it.