What you might be feeling
Extensor tendinopathy or as it is most commonly know “tennis elbow” is pain in the outside of the elbow that comes from inflammation and degeneration of the tendons on the outside of the elbow. The tendons are part of the muscles that control movements of the wrist, hand and fingers. Pain is often felt with gripping, lifting, shaking hands and using a keyboard or mouse. Extensor Tendinopathy is classified as an overuse injury occurring at the common extensor origin (CEO) on the outside of the elbow. The wrist extensor muscles are attached to the CEO via a common tendon. This overuse condition occurs due to repetitive forces at the CEO.
What’s really going on inside
Extensor tendinopathy is usually caused by activities that require repetitive use of the muscles that control the wrist, hand and fingers. The problem is felt in the tendons or CEO of these muscles, on the outside of the arm. The overuse of these muscles can cause tiny tearing and degeneration or breakdown of the tendon. This series of events then leads to an increased blood vessel growth, that relates to an increase pain rather then healing. This is further complicated by an increase of nerve fibers. These new fibers pick up painful stimuli and this coincides with an increased in pain producing chemicals to the area. It can become a very painful and debilitating condition.
Extensor tendinopathy starts as pain in the outside of the elbow and forearm. The pain usually develops gradually. Initially it may only be painful with activity and may disappear as you warm up and then return once you have stopped activity. You may notice initially that the elbow and forearm feel a bit stiff and that this discomfort will disappear with some gentle stretching and heat (e.g. a hot shower). As the condition progresses it becomes painful with most arm, wrist and hand movements and as the tendinopathy worsens it may become painful all the time.
How a physio can help
Extensor tendinopathy generally doesn’t get better on its own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly prolong the recovery time.
The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon.
Early treatment may include:
- Rest from provocative activities.
- Ice or heat (as directed by your physiotherapist).
- Physiotherapy electrotherapy modalities.
- A gentle stretching and strengthening program.
- Massage and soft tissue therapy.
- Posture education-posture of the wrist and general upright posture (especially for people who have a sedentary job and who use the computer a lot)
- Bracing or taping may be used to unload the muscle and tendon. Acupuncture and dry needling.
Once your pain has settled it is vital that physiotherapy is progressed to ensure complete healing of the area. Treatment may include:
- Harder and more specific exercises. Once you have mastered basic muscle contractions your physiotherapist will progress you on to eccentric exercises which will help to restore the integrity of the tendon.
- Correction of any predisposing or unusual biomechanics. This may relate to sport; for example using the wrist to hit a backhand in tennis rather then hit- ting with a stable wrist/forearm. Poor lifting/working technique within the workplace can also be a major predisposing factor. Your physiotherapist will guide you to help change/correct these.
Other things that may be used if the condition doesn’t settle are:
- Corticosteroid injection.
- Nitric Oxide therapy.
Your physiotherapist will guide you through your rehabilitation and refer you on to the appropriate specialist if the condition does not improve.
When can you return to sport or activity?
It is important that you return to sport or aggravating activities slowly. De- pending on the severity of the initial condition and the length of rehabilitation a graduated return may take 3 weeks or 3 months.
What is the prognosis?
Extensor tendinopathy, if treated properly and managed correctly will not have any long term effects. If not it can lead to prolonged pain on the outside of the elbow and forearm, a prolonged period away from sport/work/aggravating activities and may cause degeneration of the tendons which will cause lingering pain.