Tennis elbow is the term sometimes given to pain on the outside of the elbow but is often not caused by racket sports at all.

Pain when picking up a cup (or weapon), bending or straightening the elbow, shaking hands or gripping may be present with this condition.

The condition often arises when the tendon and/or muscle fibres of the extensor carpi radialis brevis muscle are damaged due to some form of strong repetitive activity involving extension (backward bending) of the wrist.

Activities such as forearm strengthening exercises, hammering, painting and bricklaying may contribute to the over use of this muscle.

Golf, tennis, squash and badminton strokes can also cause this condition when technique, grip size, string tension and size of club or racquet are not optimally matched to the player.

The incidence of this condition increases after 40 years of age due to decreased nutrition in the injured area and is more prevalent in men than women.

The region where the tendon fibres join the bone has a poor blood supply and, therefore, healing is slower and easily disrupted by returning to sport or the aggravating activity too soon.

This cycle of injury and incomplete healing can produce microfractures, calcification, weak regenerated tissue and scar tissue further hindering complete recovery.

Several other conditions may be confused with this pathology, so careful assessment and treatment by a doctor or physiotherapist is essential to recovery.

Inflammation of fat pads or bursae, nerve entrapment, sprained ligament and cervical or thoracic joint dysfunction need to be assessed for involvement.

Treatment in the early stages consists of pain relief and preventing further damage.

Modalities such as ice massage, compression bandage, anti-inflammatory medication, gentle stretching, isometric contractions of the wrist extensor muscles and rest from the aggravating activity decrease discomfort and improve function.

As pain decreases and healing continues techniques can be introduced:

• Massage.
• Trigger point therapy.
• Mobilisation of cervical and thoracic spinal joints.
• Laser therapy.
• Shoulder muscle stabilising exercises.
• Mobilisation of neural tissue and concentric and eccentric muscle exercises using light weights.
• Elastic tubing may be introduced.

Bracing the area with a tight band around the muscle is often effective in reducing the tension on the tendon-bone junction.

Attention to the aggravating activity will assist in preventing the condition from recurring.

Biomechanical analysis of the activity may reveal technique or apparatus deficiencies.

If a racquet sport is involved, technique adjustments that may be required include timing of impact with the ball and top-spin and backhand shots where generated forces create increased tension on the tendon-bone junction.

Also, the size of the racquet head, wet tennis balls, thickness of the grip, material the racquet is made of and string tension may contribute to excessive torque forces.

In cases that do not respond adequately to this treatment and preventive regime, corticosteroid injections or surgery may be options worth considering.

• References:
  Brukner, P., & Khan, K., (2001). Clinical Sports Medicine, 2nd edition, McGraw-Hill, Sydney.
  Zuluaga, M., et al (ed), (2000). Sports Physiotherapy, Churchill Livingstone, Melbourne.

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