Understanding Lateral Epicondylitis (Tennis Elbow): From Pathology to Rehabilitation
Do you ever have pain on the lateral portion (outside) of your elbow and throughout the top portion of your forearm? Lateral epicondylitis (Tennis elbow) is often associated with pain on the lateral aspect of the elbow and results secondary to overuse and repetitive strain on the extensor musculature that runs along the back of the forearm.
Pain is often present with extensive grasping, wrist extension, and forearm supination (turning the forearm over so that the palm is facing towards the ceiling).
Causes of Tennis Elbow
- Despite the contrary belief of the inflammatory nature, one of the causes of the condition is due to degenerative changes to the extensor musculature (extensor carpi radialis brevis primarily).
- Job related tasks or occupational activity that involve repetitive strain on the extensor musculature.
- Repetitive wrist extension and forearm supination
- Poor ergonomics in the completion of functional activities
Conservative Treatment vs Surgery
Generally, conservative treatment through occupational therapy and physical therapy is often recommended through a stretching and strengthening protocol to facilitate decreased pain, improved grasping tolerance. and improved pain free ROM. It has been shown that up to 95% of individuals that are diagnosed with lateral epicondylitis improve with non-operative treatment (3).
In addition to this, a recent systematic review and meta analysis showed that the utilization of occupational therapy or physical therapy helped to improve pain (mean difference of 7.5). (1) Wear of a brace or the use of kinesio tape has also been shown to decrease pain that an individual is experiencing associated with this condition. In recent studies, it has been noted that kinesiotape has helped with pain, grip strength, and decreased adverse events (5).
In the utilization of injections as another conservative measurement, it was indicated that both electrophysiotherapy and injections resulted in higher levels of adverse effects in comparison to occupational or physical therapy. The use of corticosteroid injections alone may help to decrease pain in the short term but do not pose a long term solution rather serve as a temporary patch to the problem at hand (1).
In recent research studies, it has been noted that guidelines have indicated minimal to no benefit of surgical management in comparison to conservative treatment (3). Surgery is a much more rare occurrence with this condition as surgery is generally only considered following an extensive period (1 year or greater) of pain with no lessening of symptoms following utilization of conservative measures.
Perhaps the most common type of surgery that is performed is release and debridement of the Extensor Carpi radialis Brevis (one of the muscles attaching to the lateral epicondyle) in attempts to alleviate the symptoms that are associated with this condition. Despite this, modified arthroscopic tenotomy or arthroscopic debridement techniques can be used to help improve pain and function as indicated within recent studies (4).
Rehabilitation & Treatment Options
Based on the research, it is often first recommended to utilize rehab services through occupational therapy or physical therapy to decrease pain and improve overall function. Rehabilitation should involve components such as activity modification, stretching exercises, gradual strengthening of the surrounding forearm musculature, and workplace adjustment. Modalities, bracing, and kinesio taping may be used as advised by a clinician.
In a 2022 systematic review, it was concluded that manual therapy paired with eccentric strengthening have been found to be two of the most beneficial components of rehabilitation (2). This eccentric training helps to aid in collagen synthesis and tendon remodeling (2).
In summary, effective rehabilitation of Lateral Epicondylitis requires a progressive, patient-centered approach that combines load management, targeted strengthening, and functional retraining to restore pain-free movement and reduce the risk of recurrence.
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References
[1] Kim, Y. J., Wood, S. M., Yoon, A. P., Howard, J. C., Yang, L. Y., & Chung, K. C. (2021). Efficacy of Nonoperative Treatments for Lateral Epicondylitis: A Systematic Review and Meta-Analysis. Plastic and reconstructive surgery, 147(1), 112–125. https://doi.org/10.1097/PRS.0000000000007440
[2] Landesa-Piñeiro, L., & Leirós-Rodríguez, R. (2022). Physiotherapy treatment of lateral epicondylitis: A systematic review. Journal of back and musculoskeletal rehabilitation, 35(3), 463–477. https://doi.org/10.3233/BMR-210053
[3]vMuir, D., Blakeway, H., Morris, R., Narvani, A. A., Elgebaly, A., & Imam, M. A. (2024). Surgical management of lateral epicondylitis: a scoping review of published literature. JSES reviews, reports, and techniques, 5(1), 79–85. https://doi.org/10.1016/j.xrrt.2024.08.008
[4]Yang, X., Ying, L., Ying, L., Zhang, Q., Han, D., & Zhou, X. (2024). Modified arthroscopic tenotomy of the extensor carpi radialis brevis for refractory lateral epicondylitis: a cohort study. Journal of shoulder and elbow surgery, 33(3), 536–543. https://doi.org/10.1016/j.jse.2023.09.036
[5] Zhong, Y., Zheng, C., Zheng, J., & Xu, S. (2020). Kinesio tape reduces pain in patients with lateral epicondylitis: A meta-analysis of randomized controlled trials. International journal of surgery (London, England), 76, 190–199. https://doi.org/10.1016/j.ijsu.2020.02.044
