Lateral Epicondylitis (Tennis Elbow)

Lateral Epicondylitis (Tennis Elbow)

 

Lateral epicondylitis (Tennis Elbow) 

What is it

Lateral epicondylitis also known as tennis elbow is a repetitive overuse injury in the forearm and elbow that is caused by inflammation on the proximal attachment of the tendon of the extensor carpi radialis brevis muscle, which is a muscle on the dorsal aspect of your forearm.

Why does it occur

This inflammation is caused by an excessive amount of load which can be done through gripping and wrist extension movements which puts too much load on the tendon therefore causing inflammation and pain. Another reason why tennis elbow or lateral epicondylitis may occur is due to poor mechanics of the hand and wrist, elbow or even the shoulder which can cause compensatory patterns therefore causing more stress and load on the extensor carpi radialis brevis tendon.

 

Signs and symptoms

The signs and symptoms of lateral epicondylitis/ tennis elbow are:

–           Pain in the elbow with gripping, lifting objects,

–           Any wrist extension that causes pain

–          Pain with a gradual onset

–           Pain at night

–           Weak grip strength / with pain

–           Swelling around the elbow

–           Tenderness and stiffness in the elbow

 

Management / Treatment options

Ice/ cold therapy: Implementation of cold therapy and ice therapy has been proven to decrease pain in inflammation to the effected tendon. This can be an easy way to reduce pain and swelling in the area.

Exercise prescription:  Strengthening exercises have been shown to increase muscle and tendon strength while also reducing pain levels. The Eccentric load of the muscle and tendon has proven to be beneficial in providing symptom relief.  Some of the results that eccentric strength training has provided include increased functions like grip strength, range of motion before the point of pain, and load capacity in everyday activities. This suggests that strength training focussing on the eccentric part of the movement provided the most effective results for lateral epicondylitis. (Chen & Baker, 2021)

Anti-Inflammatory medication: Can be used to decrease inflammation but is recommended only for a short period of time for up to 5 days. This is not a long-term management strategy. These can be useful for speeding up the healing process.

Bracing / Strapping: Taping and bracing has been shown to increase grip strength and reduce pain intensity and pain with pressure. This can provide support and relief to the tendon reducing load and increase the tendons’ ability to begin to heal. (Rodruigues & Syrivastava, 2021)

Needling: Dry needling has been proven to decrease pain intensity, increase grip strength, and increase functional capabilities.

Corticosteroid injection: Corticosteroid injection is an option for lateral epicondylitis/ tennis elbow as studies have shown that in some cases it can provide pain relief and decreased inflammation therefore allowing patients to complete daily tasks easier. (Saccomani, 2010)

 

When to consider or go for surgery?

As osteopaths, we advocate for a conservative approach to injury management and treatment before considering surgical intervention. We prioritise non-invasive techniques to promote healing and restore function. However, if pain persists, worsens, or significantly impairs daily activities over an extended period without improvement, surgical options may be considered as a last resort.

How can osteopathy help?

At our clinic, we provide comprehensive care utilising a range of techniques and management strategies to alleviate pain and enhance function. Our treatment approach considers various factors, including workplace and home ergonomics, joint alignment, and activity modifications to reduce strain on the affected area. We aim to facilitate pain relief and promote recovery, we incorporate specialised techniques such as dry needling, taping, soft tissue massage, and targeted interventions for muscles and ligaments in the hand, wrist, elbow, and shoulder. Our goal is to optimise rehabilitation and support long-term musculoskeletal health.

 

Reference list

Chen, Z., Baker, N, A. (2021). Effectiveness of eccentric strengthening in the treatment of lateral elbow tendinopathy: A systematic review with meta-analysis, Science Direct, 34, 1, 18-28. https://doi.org/10.1016/j.jht.2020.02.002

​ Ma, K., & Wang, H. (2020). Management of lateral epicondylitis: A narrative literature review. Pain Research and Management, 2020, Article 6965381. https://doi.org/10.1155/2020/6965381

Özünlü Pekyavaş, N., & Cerezci Duygu, S. (2022). Which cold application is more effective for tennis elbow? Cooling gel vs cold pack. International Journal of Disabilities Sports and Health Sciences, 5(1), 16–21. https://doi.org/10.33438/ijdshs.1039813

Saccomanni, B. (2010). Corticosteroid injection for tennis elbow or lateral epicondylitis: A review of the literature. Current Reviews in Musculoskeletal Medicine, 3(1–4), 38–40. https://doi.org/10.1007/s12178-010-9066-3

Xia, M. B., Yaqin, Q. B., Jinyang, W. M., Anke, X., & Jiteny, R. (2024). Therapeutic effects of dry needling on lateral epicondylitis: An updated systematic review and meta-analysis. Science Direct, 105(11). https://doi.org/10.1016/j.apmr.2024.02.713

Yoon, S. Y., Kim, Y. W., Shin, I. S., Kang, S., Moon, H. I., & Lee, S. C. (2021). The beneficial effects of eccentric exercise in the management of lateral elbow tendinopathy: A systematic review and meta-analysis. Journal of Clinical Medicine, 10(17), 3968. https://doi.org/10.3390/jcm10173968

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Carpal Tunnel Syndrome

Carpal Tunnel Syndrome

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome is a common condition, affecting approximately 3% to 6% of adults in the general population it is also known as median nerve entrapment. Carpal tunnel syndrome occurs when the median nerve is compressed by a ligament that runs directly across the wrist, with nerves running under it. This leads to the entrapment of the median nerve. While the median nerve extends down the entire arm, the affected area is specifically at the wrist, just before it reaches the palm. (Sevy et al, 2023)

 

Why Does it Occur

The reason why carpal tunnel or median nerve entrapment occurs can be due to a range of potential factors that decrease the space between the ligament (flexor retinaculum)  and the structures underneath (muscles, tendons, and nerves) then the ligament begins to press on other structures like the median nerve which leads to pain felt at the fingers, wrist, and forearm. These risk factors include: inflammation of structures that pass under the flexor retinaculum (carpal tunnel ligament) which can be caused by:   repetitive hand movements, history of wrist injuries, obesity, arthritis (Rheumatoid arthritis), Hormonal changes like menopause, pregnancy or diabetes and age.  (Sevy et al, 2023)

 

Signs and Symptoms

Some signs and symptoms include numbness and tingling in the thumb index and middle finger on the palmar aspect of the hand, weakness and pain gripping objects, pain worse at night in the wrist and hand that can prevent sleep and swelling in the fingers.

 

Treatment options

Some of the different treatment options for carpal tunnel/Median nerve entrapment include:

Ice therapy can be used to reduce the inflammation that is pressing on the median nerve. The ice helps constrict the (flexor retinaculum ligament) to give the median nerve more space and less compression therefore decreasing pain. (Laymon et al, 2015)

Surgery: In the surgery, they will cut the flexor retinaculum which forms the roof of the carpal tunnel which prevents the nerve from being compressed or entrapped. (National Library of Medicine, 2024)

Wrist splints: Wrist splinting and immobilising the hand and wrist can provide support and allow the body to time to recover. Night splinting is a useful strategy to decrease pain.  This can help decrease the irritation/ inflammation of the structures that pass through the carpal tunnel.

(Karjalainen et al, 2023)

Exercise therapy: Forms of exercises that can be implemented in the rehab of carpal tunnel to decrease pain and improve function. Exercise can also be used as a tool to measure progress. Some of the exercises are stretching in the forearm flexors and nerve glides.

Ergonomic changes:  Ergonomic changes in everyday tasks or at work can improve symptoms and limit reaggravation which will help the condition improve and recover at a faster rate. Some ergonomic changes include: using tools to pick things up limiting gripping motions, using an open-handed grip to pick things up, using both hands rather than one hand, Lifting lighter loads, altering bottle feeding positions, and many more. By implementing these strategies this can improve quality of life and speed up the recovery process. (Conor et al, 2012)

Steroid injections: Corticosteroid injections are used to provide temporary relief however they have not shown promising long-term effects. The steroid injection is a more effective way to be administered than oral steroid tablets. (National Library of Medicine, 2024)

 

When to go for surgery

As osteopaths, we recommend initially adopting a conservative treatment approach. However, if the condition persists and the pain becomes severe or significantly impacts daily activities, surgical intervention may be necessary for optimal patient outcomes.

 

How can osteopathy help?

As an osteopath we can help with a conservative approach to the management of the condition through the use of a range of techniques and approaches these include:  soft tissue massage, ergonomic changes within your daily activities to help take the pressure and reduce inflammation on that area, Dry needling, joint mobilization, nerve glides, and joint manipulation. These techniques aim to decrease your pain, increase function, and get you back to normal function as fast as possible. 

 

References:

Institute for Quality and Efficiency in Health Care (IQWiG). (2024). Carpal tunnel syndrome: Learn more – How effective are steroids? In InformedHealth.org. https://www.ncbi.nlm.nih.gov/books/NBK279598/

Karjalainen, T. V., Lusa, V., Page, M. J., O’Connor, D., Massy-Westropp, N., & Peters, S. E. (2023). Splinting for carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2023(2), Article CD010003. https://doi.org/10.1002/14651858.CD010003.pub2

Laymon, M., Petrofsky, J., McKivigan, J., Lee, H., & Yim, J. (2015). Effect of heat, cold, and pressure on the transverse carpal ligament and median nerve: A pilot study. Medical Science Monitor, 21, 446–451. https://doi.org/10.12659/MSM.892462

O’Connor, D., Page, M. J., Marshall, S. C., & Massy-Westropp, N. (2012). Ergonomic positioning or equipment for treating carpal tunnel syndrome. Cochrane Database of Systematic Reviews, 2012(1), Article CD009600. https://doi.org/10.1002/14651858.CD009600

Sevy, J. O., Sina, R. E., & Varacallo, M. A. (2023). Carpal tunnel syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448179/

 

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