May 18, 2022
One of the most common conditions of the elbow that we see in our clinic at Dural Health is lateral epicondylopathy. Many people know this as tennis elbow, but the technical term is lateral epicondylopathy as this more accurately describes the irritation to the forearm muscle tendons as they attach to the bony part of the arm called the lateral epicondyle. Less and less people are actually coming in saying they play tennis that caused it, and it is much more common for people to report a history of overusing their hands and forearms such as with repetitive gripping, carrying, or typing.
If we look under a microscope at the tendons of the elbow in people with lateral epicondylopathy, we see strange changes to cells that makeup the tendons, with more blood vessels, and very disorganised collagen fibres (kind of like uncooked straight spaghetti compared to cooked messy curvy spaghetti). This often happens when the tendons are put under constant strain or compression, which starts to stress them out. Normally, we can recover if we use use our tendons (such as a day in the garden cutting some branches) as long as we rest it enough afterwards (often 3 days to fully recover). But when we stress these tendons and do it continuously without a good rest (cutting branches for 8 days in a row), then the tendons can become inflamed and begin to change.
Most people with lateral epicondylopathy will report pain on the outside of their elbow, which is worse with:
It is quite easy for your General Practitioner, Physiotherapist, or Chiropractor to figure out if you have lateral epicondylopathy with just a few questions and physical examination tests. This often involves Maudsley's test, where the practitioner pushes against your middle finger to try reproduce your elbow pain. When this is positive, it is quite likely you do have lateral epicondylopathy. Other things include testing your grip strength, shoulder strength, and feeling for tenderness over the bony part on the outside of your elbow (lateral epicondyle).
Other investigations such as ultrasound scans and MRI scans can also be used, as these can show any possible tears or signs of the radial nerve being irritated. Scans like these are not that necessary though, as they rarely change treatment if you have not had any yet.
The best management of Lateral epicondylopathy involves:
At Dural Health, our Physiotherapists and Chiropractors will start by trying to understand how your condition developed. Identifying, reducing, or avoiding any activities that might be triggering the lateral epicondylopathy is important to giving it sufficient rest to recover. We find that people can just be unaware of what might be contributing to it and a simple change to the way they hold their wrist whilst gripping and and holding things can help reduce excessive strain on the elbow tendons.
We then usually measure your grip strength using a grip dynamometer which accurately tells us how strong your grip is. Weak grip strength can place you at higher risk of developing lateral epicondylopathy, and getting an accurate reading is ideal. We like to see a reading of 30kg or more for normal healthy adults, which is the same amount required to become a Police officer in Australia! We can also use other dynamometers to measure how strong your other arm muscles are (like your shoulder) to see if that weakness might have led to the elbow being overused.
Depending on what we find during the examination, we might also use some special treatment techniques like:
We then start testing out which exercises will help you best, and most of them will involve some resistance of the wrist going into extension to gently strain the tendons. Tendons need a small amount of strain to recover and work normally, but this can't be too much (or we overuse it and add to the problem!). Rest in between exercise sessions is crucial to allow it to recover, before we hit it again.
Eventually once the pain settles down, it is important we consider the whole arm as a team, so we start to build up some big muscles around the hand, shoulder, and even middle back. This is probably the most important part to make sure it doesn't come back!
Most episodes of lateral epicondylopathy will recover within 6-12 months. With a good treatment plan to settle the pain, reducing any aggravating activities, and an exercise program to build back up the strength and endurance of the entire arm, people can experience only minimal discomfort as the elbow recovers in this time. With no treatment, the condition tends to frequently come and go over time. People will do less when their elbow hurts, which allows the tendon to recover, but then the tendon is still not fully rehabilitated which means it can take less and less to trigger the next episode.
At Dural Health, all our Physiotherapists and Chiropractors provide our patients with an ongoing program to keep their arm strong, because prevention really is the best way to reduce the risk of this issue from coming back.
If you live in the Dural, Kenthurst, or Glenhaven area and feel like you might be experiencing tennis elbow or lateral epicondylopathy, make an appointment with one of our Physiotherapists, Chiropractors, or Exercise Physiologists at Dural Health by calling us on 02 8428 0555 or booking in online today!